Healthcare Provider Details

I. General information

NPI: 1275091191
Provider Name (Legal Business Name): WANG ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PRICE AVE
NARBERTH PA
19072-1917
US

IV. Provider business mailing address

3421 ENGLEWOOD ST
PHILADELPHIA PA
19149-1611
US

V. Phone/Fax

Practice location:
  • Phone: 267-671-7770
  • Fax:
Mailing address:
  • Phone: 267-671-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHUNWEI WANG
Title or Position: OWNER
Credential: ACUPUNCTURIST
Phone: 267-671-7770