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General NPI Number Information
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NPI Number | 1457601593
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Entity Type | Individual
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Provider Name | TAO WANG DPT, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1509 WILSON TER
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City | GLENDALE
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State | CA
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Zip | 91206-4007
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Country | US
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Telephone | 818-409-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 305 SAN MARCOS ST UNIT A
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City | SAN GABRIEL
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State | CA
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Zip | 91776-4354
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT39391
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License Number State | CA
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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 | 19485
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License Number State | CA
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