Healthcare Provider Details

I. General information

NPI: 1033483029
Provider Name (Legal Business Name): AIMIN WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE STE 121
CHINO CA
91710-1404
US

IV. Provider business mailing address

13768 ROSWELL AVE STE 121
CHINO CA
91710-1404
US

V. Phone/Fax

Practice location:
  • Phone: 626-202-8125
  • Fax: 909-902-6317
Mailing address:
  • Phone: 626-202-8125
  • Fax: 909-902-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: