Provider Demographics
NPI:1487877205
Name:DING, JIANSAN (ACUPUNCTURIST (ALC))
Entity type:Individual
Prefix:
First Name:JIANSAN
Middle Name:
Last Name:DING
Suffix:
Gender:M
Credentials:ACUPUNCTURIST (ALC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14846 AVENIDA ANITA
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6223
Mailing Address - Country:US
Mailing Address - Phone:909-636-3849
Mailing Address - Fax:
Practice Address - Street 1:8891 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1618
Practice Address - Country:US
Practice Address - Phone:909-865-9810
Practice Address - Fax:909-620-6724
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist