Provider Demographics
NPI:1912540493
Name:DU, JIANG (DOM)
Entity Type:Individual
Prefix:DR
First Name:JIANG
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SHALLOTTE RDG
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-9131
Mailing Address - Country:US
Mailing Address - Phone:828-508-1371
Mailing Address - Fax:
Practice Address - Street 1:1 KENILWORTH KNLS STE 7
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2084
Practice Address - Country:US
Practice Address - Phone:828-399-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-1057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist