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General NPI Number Information
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NPI Number | 1306069109
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Entity Type | Organization
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Legal Business Name | ATLANTIC HEALTHCARE
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 901 E VALLEY BLVD
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3608
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Country | US
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Telephone | 626-308-0805
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Fax | 626-280-1616
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Provider Business Mailing Address
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Address Line | 901 E VALLEY BLVD
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3608
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Country | US
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Telephone | 626-308-0805
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Fax | 626-280-1616
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PHILIP Z WANG
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Credential | L. AC.
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Telephone | 626-308-0805
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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 | AC8801
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A72461
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A72461A
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License Number State | CA
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