Healthcare Provider Details

I. General information

NPI: 1811465156
Provider Name (Legal Business Name): NA WANG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 SPRINGFIELD BLVD
BAYSIDE NY
11364-2337
US

IV. Provider business mailing address

11 BROADWAY STE 336
NEW YORK NY
10004-1549
US

V. Phone/Fax

Practice location:
  • Phone: 626-215-3602
  • Fax:
Mailing address:
  • Phone: 626-215-3602
  • Fax: 212-361-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006157
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: