MEDICARE: JIACHEN WANG L.AC.

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	20047	CA

General Provider Information

NPI Number	:	1588415780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIACHEN WANG L.AC.

Provider Business Mailing Address
First Line	:	341 CASTRO ST STE D
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1296
Country	:	US
Telephone Number	:	650-605-5721
Fax Number	:	408-414-7732

Provider Business Practice Location Address
First Line	:	341 CASTRO ST STE D
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94041-1296
Country	:	US
Telephone Number	:	650-605-5721
Fax Number	:

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

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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