Provider Demographics
NPI:1558878793
Name:DENG, JIE YAN
Entity type:Individual
Prefix:
First Name:JIE YAN
Middle Name:
Last Name:DENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S KING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2066
Mailing Address - Country:US
Mailing Address - Phone:808-348-6336
Mailing Address - Fax:808-744-8571
Practice Address - Street 1:1350 S KING ST STE 300
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2066
Practice Address - Country:US
Practice Address - Phone:808-348-6336
Practice Address - Fax:808-744-8571
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist