Provider Demographics
NPI:1811173222
Name:JIA, JING (LAC)
Entity type:Individual
Prefix:MS
First Name:JING
Middle Name:
Last Name:JIA
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 1:302 WASHINGTON BLVD
Mailing Address - Street 2:2
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5260
Mailing Address - Country:US
Mailing Address - Phone:510-687-9213
Mailing Address - Fax:510-687-9213
Practice Address - Street 1:302 WASHINGTON BLVD
Practice Address - Street 2:2
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5260
Practice Address - Country:US
Practice Address - Phone:510-687-9213
Practice Address - Fax:510-687-9213
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist