Provider Demographics
NPI:1922253707
Name:TAN, JIECHENG
Entity Type:Individual
Prefix:
First Name:JIECHENG
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5519
Mailing Address - Country:US
Mailing Address - Phone:212-431-7805
Mailing Address - Fax:212-334-7212
Practice Address - Street 1:84 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5519
Practice Address - Country:US
Practice Address - Phone:212-431-7805
Practice Address - Fax:212-334-7212
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002640171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist