Healthcare Provider Details

I. General information

NPI: 1073464509
Provider Name (Legal Business Name): XIANGHONG WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date: 07/30/2026
Reactivation Date: 09/17/2026

III. Provider practice location address

908 ARCH ST
PHILADELPHIA PA
19107-3161
US

IV. Provider business mailing address

908 ARCH ST
PHILADELPHIA PA
19107-3161
US

V. Phone/Fax

Practice location:
  • Phone: 215-392-0939
  • Fax:
Mailing address:
  • Phone: 215-392-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000269
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: