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General NPI Number Information
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NPI Number | 1912507765
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Entity Type | Organization
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Legal Business Name | WANG ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 12627 SAN JOSE BLVD STE 201
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8638
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Country | US
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Telephone | 904-437-5203
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Fax | 904-374-5354
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Provider Business Mailing Address
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Address Line | 12627 SAN JOSE BLVD STE 201
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8638
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Country | US
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Telephone | 904-437-5203
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Fax | 904-374-5354
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Authorized Official
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Title or Position | MANAGER
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Name | ROGER X WANG
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Credential | L. AC.
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Telephone | 904-607-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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