=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568359230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JIANG MOBILE MEDICAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 771 E DAILY DR STE 125
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-0709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-233-3314
-----------------------------------------------------
Fax | 833-606-3382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 771 E DAILY DR STE 125
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-0709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-233-3314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KEVIN JIANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-233-3314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------