Individual
FANG JIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 15TH ST STE 2100, SANTA MONICA, CA 90404-1101
(310) 319-1234
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
54914
CA
Other
Enumeration date
09/14/2017
Last updated
12/08/2021
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