Provider Demographics
NPI:1912293671
Name:JI, DONG (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:
Last Name:JI
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 AMERICA WAY
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3915
Mailing Address - Country:US
Mailing Address - Phone:858-349-2088
Mailing Address - Fax:858-565-0974
Practice Address - Street 1:3860 CONVOY ST
Practice Address - Street 2:SUITE 119
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3748
Practice Address - Country:US
Practice Address - Phone:858-349-2088
Practice Address - Fax:858-565-0974
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13205171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist