Healthcare Provider Details

I. General information

NPI: 1972113884
Provider Name (Legal Business Name): RUOHONG JIANG, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-63 BOWNE STREET
FLUSHING NY
11355-2642
US

IV. Provider business mailing address

41-63 BOWNE STREET
FLUSHING NY
11355-2642
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-0299
  • Fax: 718-762-0312
Mailing address:
  • Phone: 718-762-0299
  • Fax: 718-762-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUOHONG JIANG
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 718-762-0299