MEDICARE: JASON S. CHING 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	1223P0221X	Pediatric Dentistry	53202	CA

General Provider Information

NPI Number	:	1689939167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON S. CHING D.D.S., INC.

Provider Business Mailing Address
First Line	:	15218 SUMMIT AVE
Second Line	:	SUITE 150
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-333-6875
Fax Number	:	951-308-2637

Provider Business Practice Location Address
First Line	:	15218 SUMMIT AVE
Second Line	:	SUITE 150
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-333-6875
Fax Number	:	951-308-2637

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JASON CHING
Credential	:
Telephone Number	:	909-333-6875

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/30/2012

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