Healthcare Provider Details

I. General information

NPI: 1982100269
Provider Name (Legal Business Name): ALBERT JIANG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 E EDINGER AVE
SANTA ANA CA
92705-5001
US

IV. Provider business mailing address

17518 TOBOGGAN LN
ROCKVILLE MD
20855-2824
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-8904
  • Fax:
Mailing address:
  • Phone: 240-855-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT294362
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: