Basic Information
Provider Information
NPI: 1033781851
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JI
FirstName: CHENQI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1248 TULARE ST APT A
Address2:  
City: KINGSBURG
State: CA
PostalCode: 936311525
CountryCode: US
TelephoneNumber: 6503829516
FaxNumber:  
Practice Location
Address1: 1790 E MANNING AVE
Address2:  
City: REEDLEY
State: CA
PostalCode: 936549467
CountryCode: US
TelephoneNumber: 8004924227
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2021
LastUpdateDate: 07/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X106499CAY Dental ProvidersDentist 

No ID Information.


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