Healthcare Provider Details

I. General information

NPI: 1386507697
Provider Name (Legal Business Name): JIA WANG ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17017 65TH AVE
FRESH MEADOWS NY
11365-1925
US

IV. Provider business mailing address

17017 65TH AVE
FRESH MEADOWS NY
11365-1925
US

V. Phone/Fax

Practice location:
  • Phone: 347-691-8363
  • Fax:
Mailing address:
  • Phone: 347-691-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JIA WANG
Title or Position: ACUPUNCTURIST
Credential:
Phone: 347-691-8363