1164735866 NPI number — MS. JING JING DONG PA

Table of content: MS. JING JING DONG PA (NPI 1164735866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164735866 NPI number — MS. JING JING DONG PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONG
Provider First Name:
JING JING
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164735866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13336 41ST RD
Provider Second Line Business Mailing Address:
UNIT 2G
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11355-3666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-864-8648
Provider Business Mailing Address Fax Number:
718-799-1019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13336 41ST RD
Provider Second Line Business Practice Location Address:
UNIT 2G
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-864-8648
Provider Business Practice Location Address Fax Number:
718-799-1019
Provider Enumeration Date:
07/22/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  006466 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)