Healthcare Provider Details

I. General information

NPI: 1023944154
Provider Name (Legal Business Name): JIALIN HU
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: JASON HU

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAIN ST NE STE C
LOS LUNAS NM
87031-6372
US

IV. Provider business mailing address

1831 CAMINO CANTERA SW
LOS LUNAS NM
87031-8178
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-1677
  • Fax:
Mailing address:
  • Phone: 541-912-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2026-0181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: