Healthcare Provider Details

I. General information

NPI: 1316860794
Provider Name (Legal Business Name): JONATHAN C AO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 SAN BRUNO AVE
SAN FRANCISCO CA
94134-1510
US

IV. Provider business mailing address

1457 7TH AVE UNIT 2
SAN FRANCISCO CA
94122-3702
US

V. Phone/Fax

Practice location:
  • Phone: 415-656-2868
  • Fax:
Mailing address:
  • Phone: 415-990-9567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: