Provider Demographics
NPI:1184802050
Name:JIA, CHANGPING (MD)
Entity type:Individual
Prefix:
First Name:CHANGPING
Middle Name:
Last Name:JIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 MAIN ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3969
Mailing Address - Country:US
Mailing Address - Phone:718-673-2318
Mailing Address - Fax:
Practice Address - Street 1:7601 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3269
Practice Address - Country:US
Practice Address - Phone:718-238-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279254207R00000X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine