Provider Demographics
NPI:1194188102
Name:JIANG, YAN (LAC)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 SAN GABRIEL BLVD # E
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3653
Mailing Address - Country:US
Mailing Address - Phone:626-319-2725
Mailing Address - Fax:
Practice Address - Street 1:2445 SAN GABRIEL BLVD # E
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3653
Practice Address - Country:US
Practice Address - Phone:626-319-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist