Healthcare Provider Details

I. General information

NPI: 1922567924
Provider Name (Legal Business Name): SHENG JI DDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MADISON AVE STE 10
CARMICHAEL CA
95608-0645
US

IV. Provider business mailing address

6600 MADISON AVE STE 10
CARMICHAEL CA
95608-0645
US

V. Phone/Fax

Practice location:
  • Phone: 916-961-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHENG JI
Title or Position: PRESIDENT
Credential: DDS, MD
Phone: 310-866-1815