Healthcare Provider Details

I. General information

NPI: 1891238671
Provider Name (Legal Business Name): YONGQIANG WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 NORIEGA ST
SAN FRANCISCO CA
94122-4324
US

IV. Provider business mailing address

1844 NORIEGA ST
SAN FRANCISCO CA
94122-4324
US

V. Phone/Fax

Practice location:
  • Phone: 628-280-1936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: