Provider Demographics
NPI:1821051855
Name:ZHANG, JIAYU (LAC)
Entity Type:Individual
Prefix:
First Name:JIAYU
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 PENROSE PL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1818
Mailing Address - Country:US
Mailing Address - Phone:303-931-8294
Mailing Address - Fax:
Practice Address - Street 1:3405 PENROSE PL
Practice Address - Street 2:SUITE 204
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1818
Practice Address - Country:US
Practice Address - Phone:303-931-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO510171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist