Provider Demographics
NPI:1477950806
Name:JIANG, JIANYUAN (L AC)
Entity Type:Individual
Prefix:
First Name:JIANYUAN
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 VENTURA BLVD STE 343
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2516
Mailing Address - Country:US
Mailing Address - Phone:818-609-9888
Mailing Address - Fax:818-827-4748
Practice Address - Street 1:16101 VENTURA BLVD STE 343
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2516
Practice Address - Country:US
Practice Address - Phone:818-609-9888
Practice Address - Fax:818-827-4748
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist