Provider Demographics
NPI:1114195005
Name:JIANG, QIYING (LIC AC)
Entity Type:Individual
Prefix:DR
First Name:QIYING
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W 75TH ST
Mailing Address - Street 2:SUITE #207
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2384
Mailing Address - Country:US
Mailing Address - Phone:630-789-8946
Mailing Address - Fax:630-789-8946
Practice Address - Street 1:50 W 75TH ST
Practice Address - Street 2:SUITE #207
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2384
Practice Address - Country:US
Practice Address - Phone:630-789-8946
Practice Address - Fax:630-789-8946
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000062171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist