Provider Demographics
NPI:1235500448
Name:TAN, JIAHUI (LAC)
Entity Type:Individual
Prefix:MRS
First Name:JIAHUI
Middle Name:
Last Name:TAN
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 1:1302 GROSVENTRES CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6704
Mailing Address - Country:US
Mailing Address - Phone:510-586-8876
Mailing Address - Fax:
Practice Address - Street 1:2571 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1003
Practice Address - Country:US
Practice Address - Phone:408-577-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16738171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 16738OtherCALIFORNIA LICENSED ACUPUNCTURIST