Healthcare Provider Details

I. General information

NPI: 1114196490
Provider Name (Legal Business Name): HU-SHEN WANG D.O.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 STOCKTON BLVD SUITE #5
SACRAMENTO CA
95823-1633
US

IV. Provider business mailing address

6685 STOCKTON BLVD SUITE #5
SACRAMENTO CA
95823-1633
US

V. Phone/Fax

Practice location:
  • Phone: 916-428-8044
  • Fax:
Mailing address:
  • Phone: 916-428-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: