Provider Demographics
NPI:1356860019
Name:JIN, ANG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:ANG
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:430 PENINSULA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1683
Mailing Address - Country:US
Mailing Address - Phone:650-288-2716
Mailing Address - Fax:
Practice Address - Street 1:430 PENINSULA AVE STE 6
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1683
Practice Address - Country:US
Practice Address - Phone:650-288-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93026743E46182Medicaid