Healthcare Provider Details

I. General information

NPI: 1508434358
Provider Name (Legal Business Name): JINFENG JIANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 E 21ST ST
SAN BERNARDINO CA
92404-4816
US

IV. Provider business mailing address

489 E 21ST ST
SAN BERNARDINO CA
92404-4816
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-2973
  • Fax: 909-882-2681
Mailing address:
  • Phone: 909-882-2973
  • Fax: 909-882-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA209595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: