Healthcare Provider Details

I. General information

NPI: 1396185245
Provider Name (Legal Business Name): SEN WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 SIMON AVE
SAN JOSE CA
95122-1607
US

IV. Provider business mailing address

2046 SIMON AVE
SAN JOSE CA
95122-1607
US

V. Phone/Fax

Practice location:
  • Phone: 408-505-9485
  • Fax:
Mailing address:
  • Phone: 408-505-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: