Provider Demographics
NPI:1356804074
Name:ZHUANG, JIEYI (DDS)
Entity type:Individual
Prefix:
First Name:JIEYI
Middle Name:
Last Name:ZHUANG
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 1:4320 GENESEE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4900
Mailing Address - Country:US
Mailing Address - Phone:858-598-6789
Mailing Address - Fax:
Practice Address - Street 1:4320 GENESEE AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4900
Practice Address - Country:US
Practice Address - Phone:858-598-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice