Provider Demographics
NPI:1518661115
Name:JIMENEZ SANTIAGO, JAN JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:JAVIER
Last Name:JIMENEZ SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S CLARK ST UNIT 1716
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1799
Mailing Address - Country:US
Mailing Address - Phone:787-414-9626
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE # 67
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program