Healthcare Provider Details

I. General information

NPI: 1558297135
Provider Name (Legal Business Name): JADE ELIZABETH KIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PALOMBA DR STE 4
ENFIELD CT
06082-3853
US

IV. Provider business mailing address

23 SEYMOUR RD UNIT 2B
EAST GRANBY CT
06026-9604
US

V. Phone/Fax

Practice location:
  • Phone: 860-967-0606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7820
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: