Healthcare Provider Details

I. General information

NPI: 1295992774
Provider Name (Legal Business Name): KUN JIANG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 MAGNOLIA DR.
TAMPA FL
33612
US

IV. Provider business mailing address

PO BOX 198441
ATLANTA GA
30384-8441
US

V. Phone/Fax

Practice location:
  • Phone: 888-860-2778
  • Fax:
Mailing address:
  • Phone: 813-745-4673
  • Fax: 813-449-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME116086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: