Healthcare Provider Details

I. General information

NPI: 1033455381
Provider Name (Legal Business Name): JUNFANG JIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PRIDES XING STE 200
NEWARK DE
19713-6109
US

IV. Provider business mailing address

700 PRIDES XING STE 200
NEWARK DE
19713-6109
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0300
  • Fax: 302-543-8456
Mailing address:
  • Phone: 302-998-0300
  • Fax: 302-999-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC1-0011255
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: