1962662288 NPI number — JENG KUAN L.AC., D.C.

NPI Number: 1962662288
Health Care Provider/Practitioner: JENG KUAN L.AC., D.C.

NPI Number : 1962662288 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962662288",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KUAN",
    "FirstName": "JENG",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "L.AC., D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11 EDGEWOOD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MATAWAN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07747-3726",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-862-7788",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11 EDGEWOOD RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MATAWAN",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07747-3726",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-862-7788",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/10/2008",
    "LastUpdateDate": "09/20/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "AC10988",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "25MZ00066200",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "38MC00676900",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}