Healthcare Provider Details

I. General information

NPI: 1295808871
Provider Name (Legal Business Name): RONALD C K JEW DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST STREET SUITE 1516
SAN FRANCISCO CA
94102
US

IV. Provider business mailing address

490 POST STREET SUITE 1516
SAN FRANCISCO CA
94102
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-4964
  • Fax: 415-398-0147
Mailing address:
  • Phone: 415-398-4964
  • Fax: 415-398-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number25082
License Number StateCA

VIII. Authorized Official

Name: RONALD CHAUKOON JEW
Title or Position: PRESIDENT OWNER
Credential: DDS
Phone: 415-398-4964