Provider Demographics
NPI:1902782030
Name:LAO, JINGJING
Entity type:Individual
Prefix:
First Name:JINGJING
Middle Name:
Last Name:LAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JJ
Other - Middle Name:
Other - Last Name:LAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCAPP ,NBHAP
Mailing Address - Street 1:1402 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3318
Mailing Address - Country:US
Mailing Address - Phone:650-718-6666
Mailing Address - Fax:
Practice Address - Street 1:117 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1726
Practice Address - Country:US
Practice Address - Phone:650-718-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator