Provider Demographics
NPI: | 1962047076 |
---|---|
Name: | BING JIA HEALTHCARE GROUP, PLLC |
Entity type: | Organization |
Organization Name: | BING JIA HEALTHCARE GROUP, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | GOVERNOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PO-LUNG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LAC, EAMP |
Authorized Official - Phone: | 425-616-2668 |
Mailing Address - Street 1: | 693 156TH AVE SE |
Mailing Address - Street 2: | |
Mailing Address - City: | BELLEVUE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98007-5328 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 425-616-2668 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 693 156TH AVE SE |
Practice Address - Street 2: | |
Practice Address - City: | BELLEVUE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98007-5328 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-616-2668 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-11-12 |
Last Update Date: | 2019-11-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
1083130934 | Other | INDIVIDUAL NPI |