Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A168233 | CA |
N | 207T00000X | Neurosurgeon | D0082850 | MD |
NPI | 1053682971 |
---|---|
Provider Name | Bowen Jiang |
First Address | Fullerton, CA 92835-3800 |
Second Address | Fullerton, CA 92835-3813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 03/11/2021 |