=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417650623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUNPING WANG MASTER DEGREE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2023
-----------------------------------------------------
Last Update Date | 03/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3708 LYCKAN PKWY
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-2586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-481-6777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3609 UNIVERSITY DR
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-888-0423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 15239
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------