1487912838 NPI number — CHUN YI JIANG

Table of content: CHUN YI JIANG (NPI 1487912838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487912838 NPI number — CHUN YI JIANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIANG
Provider First Name:
CHUN
Provider Middle Name:
YI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JIANG
Provider Other First Name:
CHUN
Provider Other Middle Name:
YI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487912838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALHAMBRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91802-0848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-588-2566
Provider Business Mailing Address Fax Number:
626-288-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3925 ROSEMEAD BLVD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEMEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91770-1933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-588-2566
Provider Business Practice Location Address Fax Number:
626-288-1612
Provider Enumeration Date:
04/23/2012

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:  14707 , 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)