Provider Demographics
NPI:1861009474
Name:XU, JING (DDS)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LANCEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1722
Mailing Address - Country:US
Mailing Address - Phone:628-246-5645
Mailing Address - Fax:
Practice Address - Street 1:10430 S DE ANZA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3024
Practice Address - Country:US
Practice Address - Phone:669-308-1633
Practice Address - Fax:669-306-8988
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1054171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice