1407841257 NPI number — DR. JIANG RU TU LAC PHD,OMD

Table of content: DR. JIANG RU TU LAC PHD,OMD (NPI 1407841257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407841257 NPI number — DR. JIANG RU TU LAC PHD,OMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TU
Provider First Name:
JIANG
Provider Middle Name:
RU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LAC PHD,OMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407841257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1833 KEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CERRITO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94530-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-235-5166
Provider Business Mailing Address Fax Number:
510-235-5166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 PINOLE VALLEY RD
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
PINOLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94564-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-734-0467
Provider Business Practice Location Address Fax Number:
510-235-5166
Provider Enumeration Date:
09/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC4670 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)