Provider Demographics
NPI:1295286326
Name:RUAN, JAY JIAYUAN (LCSW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:JIAYUAN
Last Name:RUAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JIAYUAN
Other - Middle Name:
Other - Last Name:RUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 E GARVEY AVE S PMB 20
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2115
Mailing Address - Country:US
Mailing Address - Phone:626-539-7008
Mailing Address - Fax:
Practice Address - Street 1:9353 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1934
Practice Address - Country:US
Practice Address - Phone:626-287-2988
Practice Address - Fax:626-287-1937
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CALCSW1162391041C0700X
CAASW95048104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health