Healthcare Provider Details

I. General information

NPI: 1447423264
Provider Name (Legal Business Name): JADES DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23440 HAWTHORNE BLVD STE 110
TORRANCE CA
90505-4768
US

IV. Provider business mailing address

23440 HAWTHORNE BLVD STE 110
TORRANCE CA
90505-4768
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-8520
  • Fax: 310-373-0621
Mailing address:
  • Phone: 310-373-8520
  • Fax: 310-373-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number42742
License Number StateCA

VIII. Authorized Official

Name: SHEN LING
Title or Position: OWNER/PRESIDENT
Credential: D.M.D.
Phone: 310-373-8520