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General NPI Number Information
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NPI Number | 1336926906
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Entity Type | Individual
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Provider Name | SOPHIA JIANG DMD
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Gender | Female
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 2610 REYNOLDS RANCH PKWY STE 100
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City | LODI
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State | CA
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Zip | 95240-6890
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Country | US
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Telephone | 209-390-9379
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2682
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City | FREMONT
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State | CA
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Zip | 94536-0682
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 109321
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License Number State | CA
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