Provider Demographics
NPI:1023747896
Name:DAVIS, JESSICA MI-OHN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MI-OHN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 BRONX PARK E APT F1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7515
Mailing Address - Country:US
Mailing Address - Phone:347-301-5585
Mailing Address - Fax:
Practice Address - Street 1:2440 BRONX PARK E APT F1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7515
Practice Address - Country:US
Practice Address - Phone:347-301-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist