Healthcare Provider Details

I. General information

NPI: 1457300444
Provider Name (Legal Business Name): JIAN HANG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 5887
ALEXANDRIA LA
71307-5887
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.202763
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: