Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH071634 | PA |
NPI | 1073945598 |
---|---|
Provider Name | Qin Jiang |
First Address | Philadelphia, PA 19123-4004 |
Second Address | Philadelphia, PA 19123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2013 |
Last Update Date | 24/05/2018 |