MEDICARE: CHANGMIN JIANG MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	57660	CA

General Provider Information

NPI Number	:	1023735016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANGMIN JIANG MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	23962 ALESSANDRO BLVD STE J
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-8806
Country	:	US
Telephone Number	:	714-642-9386
Fax Number	:

Provider Business Practice Location Address
First Line	:	23962 ALESSANDRO BLVD STE J
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-8806
Country	:	US
Telephone Number	:	714-642-9386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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Directions to “ CHANGMIN JIANG MASSAGE THERAPIST” Practice Location

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