Provider Demographics
NPI:1942421060
Name:JIANG, ZHI GUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZHI
Middle Name:GUO
Last Name:JIANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4422
Mailing Address - Country:US
Mailing Address - Phone:510-873-0876
Mailing Address - Fax:510-874-7870
Practice Address - Street 1:801 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4422
Practice Address - Country:US
Practice Address - Phone:510-873-0876
Practice Address - Fax:510-874-7870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39659OtherDENDI-CAL