Provider Demographics
NPI:1174684450
Name:WANG, JIAJIE
Entity Type:Individual
Prefix:DR
First Name:JIAJIE
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10728 RAMONA BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2601
Mailing Address - Country:US
Mailing Address - Phone:626-401-0787
Mailing Address - Fax:626-401-0879
Practice Address - Street 1:10728 RAMONA BLVD STE E
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2601
Practice Address - Country:US
Practice Address - Phone:626-401-0787
Practice Address - Fax:626-401-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0052710Medicaid