Individual
DR. WILSON SHUAIWEN JING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
43000 MIDWAY DR MARINE CORP RECRUITING STATION BLDG 595, SAN DIEGO, CA 92140-4500
(619) 524-4009
Mailing address
2848 DURHAM RIDGE PL, SAN DIEGO, CA 92110-4862
(601) 750-0543
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
62950
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
10983
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
62950
CA
390200000X
Student in an Organized Health Care Education/Training Program
M12345678
MS
Other
Enumeration date
07/11/2013
Last updated
04/20/2023
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