Healthcare Provider Details

I. General information

NPI: 1043090376
Provider Name (Legal Business Name): WEN-JING WANG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENJIN WANG CHOW

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14270 MANGO DR
DEL MAR CA
92014-2927
US

IV. Provider business mailing address

14270 MANGO DR
DEL MAR CA
92014-2927
US

V. Phone/Fax

Practice location:
  • Phone: 858-847-8273
  • Fax:
Mailing address:
  • Phone: 858-847-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000130
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00231
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC3706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: