Provider Demographics
NPI:1588238406
Name:JIANG, DESAI VICTOR (MD)
Entity type:Individual
Prefix:MR
First Name:DESAI
Middle Name:VICTOR
Last Name:JIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DESAI
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 JACK MARTIN BLVD. OCEAN UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-840-2200
Mailing Address - Fax:516-572-5609
Practice Address - Street 1:317 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6338
Practice Address - Country:US
Practice Address - Phone:732-840-2200
Practice Address - Fax:516-572-5609
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2024-10-10
Deactivation Date:2022-09-27
Deactivation Code:
Reactivation Date:2022-11-16
Provider Licenses
StateLicense IDTaxonomies
NC2024-02418207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine