Healthcare Provider Details

I. General information

NPI: 1437560729
Provider Name (Legal Business Name): LING WANG ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 EL CAMINO REAL STE 418
MILLBRAE CA
94030-2643
US

IV. Provider business mailing address

475 EL CAMINO REAL STE 418
MILLBRAE CA
94030-2643
US

V. Phone/Fax

Practice location:
  • Phone: 408-930-1585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KUN XIA
Title or Position: OFFICE BILLING MANAGER
Credential:
Phone: 650-253-3159