Healthcare Provider Details

I. General information

NPI: 1104833532
Provider Name (Legal Business Name): YI WANG L.AC., DAOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EVELYN AVE STE 229
ALBANY CA
94706-1375
US

IV. Provider business mailing address

400 EVELYN AVE STE 229
ALBANY CA
94706-1375
US

V. Phone/Fax

Practice location:
  • Phone: 510-517-6341
  • Fax: 510-231-0398
Mailing address:
  • Phone: 510-517-6341
  • Fax: 510-231-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 6689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: