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General NPI Number Information
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NPI Number | 1841753076
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Entity Type | Individual
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Provider Name | LIBIN WANG
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Gender | Male
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Dates
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Enumeration Date | 04/14/2019
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Last Update Date | 04/14/2019
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Provider Practice Location Address
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Address Line | 3375 SCOTT BLVD STE 220
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City | SANTA CLARA
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State | CA
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Zip | 95054-3112
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Country | US
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Telephone | 408-425-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 2763 DORSET LN
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City | TRACY
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State | CA
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Zip | 95377-5385
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Country | US
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Telephone | 408-387-9988
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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 | AC18486
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License Number State | CA
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