Healthcare Provider Details

I. General information

NPI: 1497063127
Provider Name (Legal Business Name): YICHING WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 LEANNE TER
WALNUT CA
91789-3614
US

IV. Provider business mailing address

1537 LEANNE TER
WALNUT CA
91789-3614
US

V. Phone/Fax

Practice location:
  • Phone: 626-679-5435
  • Fax:
Mailing address:
  • Phone: 626-679-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: