MEDICARE: DR. SHAN HONG JIANG SR. LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC7362	CA

General Provider Information

NPI Number	:	1881764710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAN HONG JIANG SR. LAC

Provider Business Mailing Address
First Line	:	2338 CALLE DEL MUNDO STE A
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-1045
Country	:	US
Telephone Number	:	408-986-8598
Fax Number	:	408-986-8597

Provider Business Practice Location Address
First Line	:	2338 CALLE DEL MUNDO STE A
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-1045
Country	:	US
Telephone Number	:	408-986-8598
Fax Number	:	408-986-8597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/16/2009

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