Healthcare Provider Details

I. General information

NPI: 1578204004
Provider Name (Legal Business Name): JAMIE JIANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

4560 FLORIDA ST APT 9
SAN DIEGO CA
92116-2741
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-4032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number194282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: