MEDICARE: KEVIN NAN JIANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	269139	NY

General Provider Information

NPI Number	:	1295994572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN NAN JIANG MD

Provider Business Mailing Address
First Line	:	56-45 MAIN STREET, 4TH FLOOR SOUTH
Second Line	:	NEW YORK HOSPITAL QUEENS
City	:	FLUSHING
State	:	NY
Zip	:	11355
Country	:	US
Telephone Number	:	866-670-6824
Fax Number	:

Provider Business Practice Location Address
First Line	:	7206 NORTHERN BLVD FL 2
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1049
Country	:	US
Telephone Number	:	866-670-6824
Fax Number	:	718-533-1774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	11/15/2023

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