Provider Demographics
NPI:1073161428
Name:WANG, RUNSHENG
Entity Type:Individual
Prefix:MR
First Name:RUNSHENG
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 1:1601 DOVE ST STE 240
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2411
Mailing Address - Country:US
Mailing Address - Phone:949-932-0998
Mailing Address - Fax:949-932-0998
Practice Address - Street 1:1601 DOVE ST STE 240
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2411
Practice Address - Country:US
Practice Address - Phone:949-932-0998
Practice Address - Fax:949-932-0998
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17856171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist