MEDICARE: DR. MINCHEN WANG L.AC., PH.D

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	AC6456	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417944893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINCHEN WANG L.AC., PH.D

Provider Business Mailing Address
First Line	:	3023 BUNKER HILL ST
Second Line	:	SUITE 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-5706
Country	:	US
Telephone Number	:	858-688-7294
Fax Number	:	858-746-4212

Provider Business Practice Location Address
First Line	:	3023 BUNKER HILL ST
Second Line	:	SUITE 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-5706
Country	:	US
Telephone Number	:	858-688-7294
Fax Number	:	858-746-4212

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	11/25/2016

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