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General NPI Number Information
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NPI Number | 1154038743
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Entity Type | Individual
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Provider Name | SULAN DING
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Gender | Female
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 720 MAGNOLIA AVE STE B3
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City | CORONA
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State | CA
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Zip | 92879-3119
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Country | US
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Telephone | 951-371-8888
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Fax | 951-666-7077
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Provider Business Mailing Address
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Address Line | 2941 FLAGSTAFF DR
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City | JURUPA VALLEY
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State | CA
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Zip | 92509-1423
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Country | US
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Telephone | 626-554-0556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 91941
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License Number State | CA
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