Provider Demographics
NPI:1629546197
Name:HE, JIAO (LAC, MD)
Entity Type:Individual
Prefix:DR
First Name:JIAO
Middle Name:
Last Name:HE
Suffix:
Gender:M
Credentials:LAC, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 SUNSET DR STE 804
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5174
Mailing Address - Country:US
Mailing Address - Phone:305-662-5585
Mailing Address - Fax:305-454-6701
Practice Address - Street 1:5975 SUNSET DR STE 804
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5174
Practice Address - Country:US
Practice Address - Phone:305-662-5585
Practice Address - Fax:305-454-6701
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP663171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist