Healthcare Provider Details

I. General information

NPI: 1255126934
Provider Name (Legal Business Name): JING HUO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 04/12/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 FRANCIS LEWIS BLVD
OAKLAND GARDENS NY
11364-1054
US

IV. Provider business mailing address

4915 FRANCIS LEWIS BLVD
OAKLAND GARDENS NY
11364-1054
US

V. Phone/Fax

Practice location:
  • Phone: 516-395-0133
  • Fax:
Mailing address:
  • Phone: 516-395-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number602318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: