Healthcare Provider Details

I. General information

NPI: 1043853096
Provider Name (Legal Business Name): PENG JIANG PHARMD, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETE JIANG PHARMD, LAC

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 BETHEL RD
COLUMBUS OH
43220-1802
US

IV. Provider business mailing address

1916 BETHEL RD
COLUMBUS OH
43220-1802
US

V. Phone/Fax

Practice location:
  • Phone: 614-210-3592
  • Fax:
Mailing address:
  • Phone: 614-210-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000366
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03124437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: