Provider Demographics
NPI:1912938184
Name:JIANG, YING (LAC)
Entity Type:Individual
Prefix:
First Name:YING
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 PARKWAY DR STE 116
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1534
Mailing Address - Country:US
Mailing Address - Phone:619-229-6836
Mailing Address - Fax:619-668-1188
Practice Address - Street 1:7200 PARKWAY DR STE 116
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1534
Practice Address - Country:US
Practice Address - Phone:619-229-6836
Practice Address - Fax:619-668-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6398171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0063980Medicaid