MEDICARE: MR. JACOB J WENGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	15830	CA

General Provider Information

NPI Number	:	1053591693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB J WENGER

Provider Business Mailing Address
First Line	:	2829 CALHOUN ST
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-5406
Country	:	US
Telephone Number	:	413-588-8575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 MARINA VILLAGE PKWY STE 104
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1033
Country	:	US
Telephone Number	:	510-340-1702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	06/23/2021

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