Provider Demographics
NPI:1487912838
Name:JIANG, CHUN YI
Entity type:Individual
Prefix:
First Name:CHUN
Middle Name:YI
Last Name:JIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHUN
Other - Middle Name:YI
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-0848
Mailing Address - Country:US
Mailing Address - Phone:626-588-2566
Mailing Address - Fax:626-288-1612
Practice Address - Street 1:3925 ROSEMEAD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1933
Practice Address - Country:US
Practice Address - Phone:626-588-2566
Practice Address - Fax:626-288-1612
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14707171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist