Provider Demographics
NPI:1861633828
Name:JIANG, SIMING (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:SIMING
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1401
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-1401
Mailing Address - Country:US
Mailing Address - Phone:410-326-7000
Mailing Address - Fax:410-326-2493
Practice Address - Street 1:22454 THREE NOTCH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2052
Practice Address - Country:US
Practice Address - Phone:410-326-7000
Practice Address - Fax:410-326-2493
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered