Healthcare Provider Details

I. General information

NPI: 1568376036
Provider Name (Legal Business Name): JIANWEI DU SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 E CAMINO VIS UNIT 2
ANAHEIM CA
92807-4934
US

IV. Provider business mailing address

6519 E CAMINO VIS UNIT 2
ANAHEIM CA
92807-4934
US

V. Phone/Fax

Practice location:
  • Phone: 561-631-9206
  • Fax: 561-423-0844
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: