Healthcare Provider Details

I. General information

NPI: 1053879692
Provider Name (Legal Business Name): JIAQI WENG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10118 BANDLEY DR STE B
CUPERTINO CA
95014-2155
US

IV. Provider business mailing address

930 KIELY BLVD UNIT A
SANTA CLARA CA
95051-5016
US

V. Phone/Fax

Practice location:
  • Phone: 650-460-4669
  • Fax:
Mailing address:
  • Phone: 650-460-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: