Individual provider Active NPI

Jiaoluan Wang

  • In Home Supportive Care Agency
  • Riverside, CA
National Provider Identifier
1114813052
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
003318344 Issued in CA
Practice address
8360 Clover Creek Rd
Riverside, CA 92508-3512
Phone
(951) 542-0722
NPI assigned
Jun 17, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 47745 CA
Personal Care Attendant 3747P1801X 003318344 CA
In Home Supportive Care Agency 253Z00000X 003318344 CA Primary

Addresses

Primary practice location

8360 Clover Creek Rd
Riverside, CA 92508-3512

Mailing address

12625 Frederick St Ste E1
Moreno Valley, CA 92553-5253
Phone (951) 542-0722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
47745CAMDGeneral Practice Dentistry
003318344CAMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Cloud Holdings, LLC Massage Therapist CurrentSince Nov 24, 2025 Accepting new patients

Locations

12625 Frederick St
Ste E1
Moreno Valley, CA 92553
Phone (951) 542-0722

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1114813052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12625 FREDERICK ST STE E1",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535253",
            "telephone_number": "951-542-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8360 CLOVER CREEK RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925083512",
            "telephone_number": "951-542-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JIAOLUAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-17",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "47745",
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "CA",
            "license": "003318344",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "CA",
            "license": "003318344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.