Provider Demographics
NPI:1811638265
Name:JIANG, JONATHAN D (OTR/L)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:JIANG
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 DEXTER WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4441
Mailing Address - Country:US
Mailing Address - Phone:510-284-9004
Mailing Address - Fax:510-284-9004
Practice Address - Street 1:2401 BLANDING AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1503
Practice Address - Country:US
Practice Address - Phone:510-522-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22779225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist