Healthcare Provider Details

I. General information

NPI: 1720095540
Provider Name (Legal Business Name): LIN YING WANG OMD LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 CASTRO STREET
MOUNTAIN VIEW CA
94041
US

IV. Provider business mailing address

795 CASTRO STREET
MOUNTAIN VIEW CA
94041
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-1688
  • Fax: 650-961-1688
Mailing address:
  • Phone: 650-961-1688
  • Fax: 650-961-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: