Provider Demographics
NPI:1104597095
Name:JIANG, SHIRLEY XIAOYING (NP)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:XIAOYING
Last Name:JIANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 N PACIFIC COAST HWY STE 600
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2747
Mailing Address - Country:US
Mailing Address - Phone:310-698-5452
Mailing Address - Fax:
Practice Address - Street 1:5901 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5411
Practice Address - Country:US
Practice Address - Phone:888-641-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner