Provider Demographics
NPI:1457648412
Name:DING, JIAXI (MD)
Entity Type:Individual
Prefix:
First Name:JIAXI
Middle Name:
Last Name:DING
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 1:755 HIGHLAND OAKS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7106
Mailing Address - Country:US
Mailing Address - Phone:336-997-4599
Mailing Address - Fax:
Practice Address - Street 1:755 HIGHLAND OAKS DR STE 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7106
Practice Address - Country:US
Practice Address - Phone:336-997-4599
Practice Address - Fax:336-293-4758
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT199597207R00000X
IAMD-42630207W00000X
NC2016-00680207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCT6000355Medicare PIN