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General NPI Number Information
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NPI Number | 1609909860
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Entity Type | Organization
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Legal Business Name | JS MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 SW 41ST ST STE J
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City | RENTON
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State | WA
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Zip | 98055-4974
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Country | US
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Telephone | 425-251-8239
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Fax | 425-251-6298
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Provider Business Mailing Address
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Address Line | 101 SW 41ST ST STE J
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City | RENTON
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State | WA
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Zip | 98055-4974
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Country | US
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Telephone | 425-251-8239
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Fax | 425-251-6298
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Authorized Official
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Title or Position | OWNER
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Name | SHAN JIANG
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Credential | MD
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Telephone | 425-251-8239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00043005
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License Number State | WA
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