Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | C1-0011255 | DE |
NPI | 1033455381 |
---|---|
Provider Name | Junfang Jiao |
First Address | Newark, DE 19713-6109 |
Second Address | Newark, DE 19713-6109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 17/08/2020 |