=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922466796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JIAMIN FENG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2016
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15944 LOS SERRANOS COUNTRY CLUB DRIVE SUITE 120
-----------------------------------------------------
City | CHINO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-248-8429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15905 TANBERRY DR
-----------------------------------------------------
City | CHINO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91709-7857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-529-8658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 16763
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------