Healthcare Provider Details

I. General information

NPI: 1407264591
Provider Name (Legal Business Name): JANE JIAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JIAN JIAO

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

IV. Provider business mailing address

1802 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-5526
  • Fax:
Mailing address:
  • Phone: 925-934-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number103672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: