Healthcare Provider Details

I. General information

NPI: 1750465142
Provider Name (Legal Business Name): YAN WANG D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 WESTERFELD DR NE
ALBUQUERQUE NM
87111-3462
US

IV. Provider business mailing address

3705 WESTERFELD DR NE
ALBUQUERQUE NM
87111-3462
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-6299
  • Fax: 505-299-0149
Mailing address:
  • Phone: 505-299-6299
  • Fax: 505-299-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberNM830
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: