Provider Demographics
NPI:1922160050
Name:XA, JENNIFER TRANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TRANG
Last Name:XA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:TRANG
Other - Middle Name:THI
Other - Last Name:XA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9225 MIRA MESA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4810
Mailing Address - Country:US
Mailing Address - Phone:858-566-7645
Mailing Address - Fax:858-566-6039
Practice Address - Street 1:9225 MIRA MESA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4810
Practice Address - Country:US
Practice Address - Phone:858-566-7645
Practice Address - Fax:858-566-6039
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48407122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist