Provider Demographics
NPI:1740774066
Name:JIANG, SHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAN
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 1:16659 SOUTHWEST FWY STE 235
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2372
Mailing Address - Country:US
Mailing Address - Phone:346-874-2060
Mailing Address - Fax:346-874-2061
Practice Address - Street 1:16659 SOUTHWEST FWY STE 235
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2372
Practice Address - Country:US
Practice Address - Phone:346-874-2060
Practice Address - Fax:346-874-2061
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT5587207V00000X
TXBP10063409207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty