Provider Demographics
NPI:1205032992
Name:WEN, JIANHONG (L AC)
Entity Type:Individual
Prefix:MRS
First Name:JIANHONG
Middle Name:
Last Name:WEN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 WESTLYNN WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5863
Mailing Address - Country:US
Mailing Address - Phone:408-398-9374
Mailing Address - Fax:
Practice Address - Street 1:762 W DANA ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1304
Practice Address - Country:US
Practice Address - Phone:650-968-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 8299OtherLICENSED ACUPUNCTURIST