Provider Demographics
NPI:1063631349
Name:GANG, MAYA (PHD LAC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:GANG
Suffix:
Gender:F
Credentials:PHD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 FREELAND
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-1652
Mailing Address - Country:US
Mailing Address - Phone:949-374-3008
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE E109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2214
Practice Address - Country:US
Practice Address - Phone:949-374-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8163171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist