Provider Demographics
NPI:1871766501
Name:ZHAN, JIAYANG (MT)
Entity type:Individual
Prefix:
First Name:JIAYANG
Middle Name:
Last Name:ZHAN
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S MONITOR AVE
Mailing Address - Street 2:2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644
Mailing Address - Country:US
Mailing Address - Phone:630-771-1070
Mailing Address - Fax:
Practice Address - Street 1:303 QUADRANGLE DRIVE
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-771-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist