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General NPI Number Information
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NPI Number | 1134912967
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Entity Type | Individual
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Provider Name | JIAKUN YI RD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2025
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Last Update Date | 05/24/2025
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Provider Practice Location Address
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Address Line | 22326 EXPLORATION DR
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City | LEXINGTON PARK
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State | MD
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Zip | 20653-2020
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Country | US
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Telephone | 443-279-7989
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Fax |
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Provider Business Mailing Address
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Address Line | 1099 WINTERSON RD
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City | LINTHICUM HEIGHTS
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State | MD
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Zip | 21090-2216
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Country | US
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Telephone | 800-905-3261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DX7278
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License Number State | MD
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