Provider Demographics
NPI:1174180145
Name:ZHAO, JIE
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W BROADWAY APT 303
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1119
Mailing Address - Country:US
Mailing Address - Phone:408-816-5975
Mailing Address - Fax:
Practice Address - Street 1:18672 FLORIDA ST STE 209
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6088
Practice Address - Country:US
Practice Address - Phone:408-816-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18547171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist