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General NPI Number Information
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NPI Number | 1437586377
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Entity Type | Individual
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Provider Name | SAM J WANG LAC
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Gender | Male
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 10261 TRADEMARK ST UNIT # B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5805
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Country | US
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Telephone | 213-268-5278
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Fax | 909-948-8860
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Provider Business Mailing Address
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Address Line | 10261 TRADEMARK ST UNIT # B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5805
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Country | US
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Telephone | 213-268-5278
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Fax | 909-948-8860
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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 | AC 15365
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License Number State | CA
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