Healthcare Provider Details

I. General information

NPI: 1265752323
Provider Name (Legal Business Name): QIN WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

22 MILL STREET
ARLINGTON MA
02476
US

V. Phone/Fax

Practice location:
  • Phone: 781-641-3633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number584
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: