=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619510088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY JIANG DENTAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2019
-----------------------------------------------------
Last Update Date | 02/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 CARLMONT DR STE 8
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94002-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-830-7632
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1322
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94002-6322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-237-2036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | XINYI JIANG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 765-237-2036
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------