Healthcare Provider Details

I. General information

NPI: 1457640807
Provider Name (Legal Business Name): FENG JIANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 11/03/2023
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 HARROUN RD STE 55
SYLVANIA OH
43560
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-6599
  • Fax: 419-882-3870
Mailing address:
  • Phone: 419-824-6599
  • Fax: 419-882-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301098780
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35130255
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: