Individual
MR. JACK JIENAN FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6265 SAUNDERS ST APT 5G, REGO PARK, NY 11374-1576
(347) 205-7909
Mailing address
4323 COLDEN ST APT 19M, FLUSHING, NY 11355-5926
(347) 205-7909
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
260808
MA
208M00000X
Hospitalist Physician
Primary
260808
MA
Other
Enumeration date
04/11/2011
Last updated
03/26/2018
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