Provider Demographics
NPI:1881764710
Name:JIANG, SHAN HONG SR (LAC)
Entity type:Individual
Prefix:DR
First Name:SHAN
Middle Name:HONG
Last Name:JIANG
Suffix:SR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 CALLE DEL MUNDO STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1045
Mailing Address - Country:US
Mailing Address - Phone:408-986-8598
Mailing Address - Fax:408-986-8597
Practice Address - Street 1:2338 CALLE DEL MUNDO STE A
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1045
Practice Address - Country:US
Practice Address - Phone:408-986-8598
Practice Address - Fax:408-986-8597
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC7362Medicare PIN