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General NPI Number Information
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NPI Number | 1053471870
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Entity Type | Individual
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Provider Name | LILY WANG L.A.C
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 3600 N VERDUGO RD STE 207
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City | GLENDALE
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State | CA
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Zip | 91208-1258
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Country | US
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Telephone | 310-359-5616
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Fax |
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Provider Business Mailing Address
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Address Line | 4018 CAMERO AVE APT 3
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City | LOS ANGELES
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State | CA
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Zip | 90027-4582
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Country | US
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Telephone | 310-359-5616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001348
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 15195
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License Number State | CA
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