Provider Demographics
NPI:1407598857
Name:FANG, JONATHAN XINGUO (MBBS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:XINGUO
Last Name:FANG
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:K1930, BLOCK K, QUEEN MARY HOSPITAL, 102 POKFULAM ROAD
Mailing Address - Street 2:POKFULAM, HONG KONG
Mailing Address - City:HONG KONG
Mailing Address - State:HONG KONG
Mailing Address - Zip Code:999077
Mailing Address - Country:HK
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6106
Practice Address - Country:US
Practice Address - Phone:617-821-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPENDING207RI0011X
MA294223390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology