Healthcare Provider Details

I. General information

NPI: 1386624724
Provider Name (Legal Business Name): NING JING M.A., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RAYMOND DR #203
NAPERVILLE IL
60563-9789
US

IV. Provider business mailing address

1224 SUNNYBROOK DR
NAPERVILLE IL
60540-4137
US

V. Phone/Fax

Practice location:
  • Phone: 630-369-8878
  • Fax: 630-369-4012
Mailing address:
  • Phone: 630-428-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: