Provider Demographics
NPI:1366815771
Name:ZHANG, JACKIE LIANG SR (DOA,PHD)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:LIANG
Last Name:ZHANG
Suffix:SR
Gender:M
Credentials:DOA,PHD
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:LIANG
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DRJACKIE ZHANG
Mailing Address - Street 1:650 WEST DUARTE ROAD , # 168
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007
Mailing Address - Country:US
Mailing Address - Phone:626-203-9321
Mailing Address - Fax:626-203-9321
Practice Address - Street 1:650 WEST DUARTE ROAD , # 168
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007
Practice Address - Country:US
Practice Address - Phone:626-203-9321
Practice Address - Fax:626-446-3168
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACU14189171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC14189OtherACUPUNCTURE