Provider Demographics
NPI:1043853096
Name:JIANG, PENG (PHARMD, LAC)
Entity type:Individual
Prefix:DR
First Name:PENG
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:PHARMD, LAC
Other - Prefix:DR
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, LAC
Mailing Address - Street 1:1916 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1802
Mailing Address - Country:US
Mailing Address - Phone:614-210-3592
Mailing Address - Fax:
Practice Address - Street 1:1916 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1802
Practice Address - Country:US
Practice Address - Phone:614-210-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124437183500000X
OH65.000366171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist