Healthcare Provider Details

I. General information

NPI: 1962778746
Provider Name (Legal Business Name): CHENG WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 RHOADS AVE
NEWTON SQUARE PA
19073
US

IV. Provider business mailing address

3545 RHOADS AVE
NEWTON SQUARE PA
19073
US

V. Phone/Fax

Practice location:
  • Phone: 855-200-8228
  • Fax: 855-379-9435
Mailing address:
  • Phone: 855-200-8228
  • Fax: 855-379-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000137
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: