Provider Demographics
NPI:1124231659
Name:MING, JACOB THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:MING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:KINGSLEY
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:323 GEARY ST # 506
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-781-5232
Mailing Address - Fax:415-781-1891
Practice Address - Street 1:323 GEARY ST # 506
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-781-5232
Practice Address - Fax:417-811-8911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB3705601122300000X
CA37056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
503724Medicare UPIN