Provider Demographics
NPI:1033455381
Name:JIAO, JUNFANG
Entity Type:Individual
Prefix:
First Name:JUNFANG
Middle Name:
Last Name:JIAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PRIDES XING STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-6109
Mailing Address - Country:US
Mailing Address - Phone:302-998-0300
Mailing Address - Fax:302-999-7943
Practice Address - Street 1:700 PRIDES XING STE 200
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6109
Practice Address - Country:US
Practice Address - Phone:302-998-0300
Practice Address - Fax:302-543-8456
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011255207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology