Provider Demographics
NPI:1710043922
Name:HAO, JISHUN (DOM)
Entity Type:Individual
Prefix:
First Name:JISHUN
Middle Name:
Last Name:HAO
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:HAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOM
Mailing Address - Street 1:10151 MONTGOMERY BLVD NE STE 2A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3664
Mailing Address - Country:US
Mailing Address - Phone:505-822-9878
Mailing Address - Fax:505-822-9869
Practice Address - Street 1:10151 MONTGOMERY BLVD NE STE 2A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3664
Practice Address - Country:US
Practice Address - Phone:505-822-9878
Practice Address - Fax:505-822-9869
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist