Healthcare Provider Details

I. General information

NPI: 1275704892
Provider Name (Legal Business Name): JIAXIN NIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 08/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3359
Mailing address:
  • Phone: 480-256-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number45104
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45104
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: