Provider Demographics
NPI:1346914793
Name:TANG, JIE
Entity Type:Individual
Prefix:
First Name:JIE
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N CAPITOL AVE UNIT 282
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2359
Mailing Address - Country:US
Mailing Address - Phone:650-669-7542
Mailing Address - Fax:
Practice Address - Street 1:1885 LUNDY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1887
Practice Address - Country:US
Practice Address - Phone:408-260-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist