MEDICARE: JADEN WANG LAC

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	AC02201	TX

General Provider Information

NPI Number	:	1679367031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADEN WANG LAC

Provider Business Mailing Address
First Line	:	2404 RILEIGH LN
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6582
Country	:	US
Telephone Number	:	206-465-9339
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 CALLENDER RD STE 103
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-8869
Country	:	US
Telephone Number	:	817-592-3331
Fax Number	:

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

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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Directions to “ JADEN WANG LAC” Practice Location

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