1245697523 NPI number — JENNIFER YEUNYEE JING P.T., D.P.T.

Table of content: JENNIFER YEUNYEE JING P.T., D.P.T. (NPI 1245697523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245697523 NPI number — JENNIFER YEUNYEE JING P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JING
Provider First Name:
JENNIFER
Provider Middle Name:
YEUNYEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245697523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 S LA FAYETTE PARK PL APT 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N LAKE AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91101-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-568-9115
Provider Business Practice Location Address Fax Number:
626-568-9232
Provider Enumeration Date:
01/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  43310 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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