Healthcare Provider Details

I. General information

NPI: 1881240091
Provider Name (Legal Business Name): JUNJIAN DENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 WEBSTER ST
OAKLAND CA
94607-4220
US

IV. Provider business mailing address

132 JASPER PL
SAN FRANCISCO CA
94133-3320
US

V. Phone/Fax

Practice location:
  • Phone: 510-986-6800
  • Fax:
Mailing address:
  • Phone: 206-619-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034725
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95191190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: