Healthcare Provider Details

I. General information

NPI: 1760529895
Provider Name (Legal Business Name): YARONG WANG AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PINE WEST PLZ WASHINGTON AVE EXT
ALBANY NY
12205-5532
US

IV. Provider business mailing address

2 PINE WEST PLZ
ALBANY NY
12205-5532
US

V. Phone/Fax

Practice location:
  • Phone: 518-690-2008
  • Fax:
Mailing address:
  • Phone: 518-690-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: