Healthcare Provider Details

I. General information

NPI: 1053862466
Provider Name (Legal Business Name): WEI WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E REMINGTON DR. #25
SUNNYVALE CA
94087
US

IV. Provider business mailing address

500 E REMINGTON DR STE 25
SUNNYVALE CA
94087-2612
US

V. Phone/Fax

Practice location:
  • Phone: 408-981-8661
  • Fax:
Mailing address:
  • Phone: 408-981-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: