Provider Demographics
NPI:1457640807
Name:JIANG, FENG (MD)
Entity Type:Individual
Prefix:
First Name:FENG
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-824-6599
Mailing Address - Fax:419-882-3870
Practice Address - Street 1:5308 HARROUN RD STE 55
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-824-6599
Practice Address - Fax:419-882-3870
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098780207RH0003X
390200000X
OH35130255207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4068054OtherMI MEDICARE
OH0235437Medicaid
MI1457640807Medicaid
OHH591280OtherMEDICARE PIN