Provider Demographics
NPI:1316337199
Name:WANG, JIAN
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JINA
Other - Middle Name:F
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 AVENUE V
Mailing Address - Street 2:APT 5F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:347-322-7654
Mailing Address - Fax:
Practice Address - Street 1:18 AVENUE V
Practice Address - Street 2:APT 5F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4253
Practice Address - Country:US
Practice Address - Phone:347-322-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist