Individual
JESSE TIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10047 CROSSROAD CT SE, CALEDONIA, MI 49316-7316
(616) 685-8850
Mailing address
1900 44TH ST SE, KENTWOOD, MI 49508-5008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007292
MI
Other
Enumeration date
04/06/2015
Last updated
12/03/2021
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