Provider Demographics
NPI:1750904470
Name:DI, JINGYUAN
Entity type:Individual
Prefix:
First Name:JINGYUAN
Middle Name:
Last Name:DI
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 1:134 SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-1603
Mailing Address - Country:US
Mailing Address - Phone:310-694-2387
Mailing Address - Fax:
Practice Address - Street 1:714 W OLYMPIC BLVD STE 707
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1490
Practice Address - Country:US
Practice Address - Phone:213-749-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18874171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist