Healthcare Provider Details

I. General information

NPI: 1053574251
Provider Name (Legal Business Name): WAN SIHK KANG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44105 JACKSON ST UNIT B
INDIO CA
92201-3275
US

IV. Provider business mailing address

3200 INLAND EMPIRE BLVD SUITE 275
ONTARIO CA
91764-5513
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-5432
  • Fax: 760-863-5492
Mailing address:
  • Phone: 909-373-2412
  • Fax: 909-466-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: