Basic Information
| Provider Information | |||||||||
| NPI: | 1295164168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUAN | ||||||||
| FirstName: | JASPER | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | DUAN | ||||||||
| OtherFirstName: | JASPER | ||||||||
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| OtherCredential: | B.A. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1310 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134833000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1310 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134833000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2013 | ||||||||
| LastUpdateDate: | 11/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235500000X | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist |
No ID Information.