Provider Demographics
NPI:1053182303
Name:JIANG, CHENGLIANG
Entity type:Individual
Prefix:
First Name:CHENGLIANG
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 VFW PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3717
Mailing Address - Country:US
Mailing Address - Phone:617-417-4585
Mailing Address - Fax:
Practice Address - Street 1:907 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7415
Practice Address - Country:US
Practice Address - Phone:781-642-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA295348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist