Healthcare Provider Details

I. General information

NPI: 1114501319
Provider Name (Legal Business Name): JIANNING MAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 134TH AVE SE
BELLEVUE WA
98005-8061
US

IV. Provider business mailing address

1807 134TH AVE SE
BELLEVUE WA
98005-8061
US

V. Phone/Fax

Practice location:
  • Phone: 425-503-0244
  • Fax:
Mailing address:
  • Phone: 425-503-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: