MEDICARE: DR. JIANGIAN HU D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 19905	FL

General Provider Information

NPI Number	:	1538417910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIANGIAN HU D.M.D.

Provider Business Mailing Address
First Line	:	5218 JAMMES RD
Second Line	:	STE D
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7700
Country	:	US
Telephone Number	:	904-577-8099
Fax Number	:	904-317-9846

Provider Business Practice Location Address
First Line	:	5218 JAMMES RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7700
Country	:	US
Telephone Number	:	904-778-0990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	01/16/2014

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