Healthcare Provider Details

I. General information

NPI: 1487596110
Provider Name (Legal Business Name): KATHERINE WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N ELMHURST RD
MT PROSPECT IL
60056-1135
US

IV. Provider business mailing address

1105 N ELMHURST RD
MT PROSPECT IL
60056-1135
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-2318
  • Fax: 224-676-2319
Mailing address:
  • Phone: 224-676-2318
  • Fax: 224-676-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.011852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: