Provider Demographics
NPI:1265502694
Name:FU, JIAN-PING (PHD LAC)
Entity Type:Individual
Prefix:DR
First Name:JIAN-PING
Middle Name:
Last Name:FU
Suffix:
Gender:F
Credentials:PHD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 SANTA MONICA BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2584
Mailing Address - Country:US
Mailing Address - Phone:310-207-1007
Mailing Address - Fax:310-207-1007
Practice Address - Street 1:12340 SANTA MONICA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2584
Practice Address - Country:US
Practice Address - Phone:310-207-1007
Practice Address - Fax:310-207-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7680171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0076800Medicaid