Provider Demographics
NPI:1992917371
Name:LAN, JIAN FANG (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:FANG
Last Name:LAN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 91ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3604
Mailing Address - Country:US
Mailing Address - Phone:718-651-0678
Mailing Address - Fax:718-651-0678
Practice Address - Street 1:9001 ROOSEVELT AVE # A
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7938
Practice Address - Country:US
Practice Address - Phone:718-205-4812
Practice Address - Fax:718-205-5946
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist