Healthcare Provider Details

I. General information

NPI: 1235819368
Provider Name (Legal Business Name): JIAJING KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 BROADWAY APT 605
TACOMA WA
98402-4003
US

IV. Provider business mailing address

252 BROADWAY APT 605
TACOMA WA
98402-4003
US

V. Phone/Fax

Practice location:
  • Phone: 253-213-9025
  • Fax:
Mailing address:
  • Phone: 253-213-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN61153612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: