Active NPI
Shan Jiang, MD
- Family Medicine Physician
- Renton, WA
National Provider Identifier
1174550669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00043005
- Practice address
- 101 SW 41St St Ste J
Renton, WA 98057-4974 - Phone
- (425) 251-6650
- Fax
- (425) 251-6654
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00043005 | WA | Primary |
Addresses
Primary practice location
101 SW 41St St Ste J
Renton, WA 98057-4974
Mailing address
101 SW 41St St Ste J
Renton, WA 98057-4974
Phone (425) 251-6650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00043005 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198022400000",
"number": "1174550669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 SW 41ST ST STE J",
"city": "RENTON",
"state": "WA",
"postal_code": "980574974",
"telephone_number": "425-251-6650",
"fax_number": "425-251-6654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 SW 41ST ST STE J",
"city": "RENTON",
"state": "WA",
"postal_code": "980574974",
"telephone_number": "425-251-6650",
"fax_number": "425-251-6654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIANG",
"first_name": "SHAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00043005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.