Provider Demographics
NPI:1003031394
Name:HE, WANYI (LAC)
Entity Type:Individual
Prefix:MRS
First Name:WANYI
Middle Name:
Last Name:HE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5159 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8689
Mailing Address - Country:US
Mailing Address - Phone:925-706-1388
Mailing Address - Fax:925-978-0988
Practice Address - Street 1:5159 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8689
Practice Address - Country:US
Practice Address - Phone:925-706-1388
Practice Address - Fax:925-978-0988
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8383171100000X
MDU01453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0083830Medicaid