Healthcare Provider Details

I. General information

NPI: 1922571389
Provider Name (Legal Business Name): ZEYU WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EL CAMINO REAL
MILLBRAE CA
94030
US

IV. Provider business mailing address

660 EL CAMINO REAL STE 100
MILLBRAE CA
94030-2060
US

V. Phone/Fax

Practice location:
  • Phone: 650-684-7651
  • Fax:
Mailing address:
  • Phone: 510-676-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: