MEDICARE: MAMIE JIANG RN

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	163W00000X	Registered Nurse	95038889	CA

General Provider Information

NPI Number	:	1811599707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMIE JIANG RN

Provider Business Mailing Address
First Line	:	66 STAPLES AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-3133
Country	:	US
Telephone Number	:	415-308-3152
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 STAPLES AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-3133
Country	:	US
Telephone Number	:	415-308-3152
Fax Number	:

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

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	01/11/2022

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