Provider Demographics
NPI:1033483029
Name:WANG, AIMIN
Entity Type:Individual
Prefix:
First Name:AIMIN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13768 ROSWELL AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1404
Mailing Address - Country:US
Mailing Address - Phone:626-202-8125
Mailing Address - Fax:909-902-6317
Practice Address - Street 1:13768 ROSWELL AVE STE 121
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1404
Practice Address - Country:US
Practice Address - Phone:626-202-8125
Practice Address - Fax:909-902-6317
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8816171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist