Provider Demographics
NPI:1831437854
Name:SHANG, JIEMIN
Entity type:Individual
Prefix:MR
First Name:JIEMIN
Middle Name:
Last Name:SHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 41ST RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4353
Mailing Address - Country:US
Mailing Address - Phone:347-506-0706
Mailing Address - Fax:347-506-0747
Practice Address - Street 1:13235 41ST RD STE 1A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4353
Practice Address - Country:US
Practice Address - Phone:347-506-0706
Practice Address - Fax:347-506-0747
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker