Healthcare Provider Details

I. General information

NPI: 1528994308
Provider Name (Legal Business Name): JIANFANG DENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5688 N CHARLOTTE AVE
SAN GABRIEL CA
91776-1606
US

IV. Provider business mailing address

5688 N CHARLOTTE AVE
SAN GABRIEL CA
91776-1606
US

V. Phone/Fax

Practice location:
  • Phone: 909-203-6818
  • Fax:
Mailing address:
  • Phone: 909-203-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberAU95JD1AE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: