Healthcare Provider Details

I. General information

NPI: 1972763753
Provider Name (Legal Business Name): CHAOYONG JIANG L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 06/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 NOLAND RD SUITE 0
KANSAS CITY MO
64133-2799
US

IV. Provider business mailing address

11900 W 101ST TER
LENEXA KS
66215-1967
US

V. Phone/Fax

Practice location:
  • Phone: 816-353-3063
  • Fax: 816-353-3064
Mailing address:
  • Phone: 913-599-0898
  • Fax: 913-871-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2002010025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: