Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A142275 | CA |
NPI | 1043590649 |
---|---|
Provider Name | Fonda Jiang |
First Address | Long Beach, CA 90808-2145 |
Second Address | Long Beach, CA 90808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2011 |
Last Update Date | 27/07/2018 |