MEDICARE: JISHEN NA, D.D.S. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	45933	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023221595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JISHEN NA, D.D.S. INC

Provider Business Mailing Address
First Line	:	40928 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-656-9998
Fax Number	:

Provider Business Practice Location Address
First Line	:	40928 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-656-9998
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. JISHEN NA
Credential	:
Telephone Number	:	510-656-9998

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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