Provider Demographics
NPI:1023322427
Name:JING RIVER ACUPUNCTURE AND TRADITIONAL MEDICINE, LLC
Entity type:Organization
Organization Name:JING RIVER ACUPUNCTURE AND TRADITIONAL MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:L.AC.
Authorized Official - Prefix:
Authorized Official - First Name:XIANGDONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-674-3351
Mailing Address - Street 1:925 HIGHWAY 55
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3734
Mailing Address - Country:US
Mailing Address - Phone:651-674-3351
Mailing Address - Fax:
Practice Address - Street 1:925 HIGHWAY 55
Practice Address - Street 2:SUITE 105
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3734
Practice Address - Country:US
Practice Address - Phone:651-674-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1406616302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization