Provider Demographics
NPI:1326163619
Name:ZHAO, LAN JIAN (NCCAOM-ACUPUNCTURE)
Entity Type:Individual
Prefix:MRS
First Name:LAN
Middle Name:JIAN
Last Name:ZHAO
Suffix:
Gender:F
Credentials:NCCAOM-ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2407
Mailing Address - Country:US
Mailing Address - Phone:773-355-5052
Mailing Address - Fax:773-355-5052
Practice Address - Street 1:4112 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2407
Practice Address - Country:US
Practice Address - Phone:773-355-5052
Practice Address - Fax:773-355-5052
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist