Provider Demographics
NPI:1073604583
Name:WANG, JIANG (DOM)
Entity Type:Individual
Prefix:DR
First Name:JIANG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 PENNSYLVANIA CIR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7827
Mailing Address - Country:US
Mailing Address - Phone:505-265-5168
Mailing Address - Fax:505-265-5168
Practice Address - Street 1:7900 PENNSYLVANIA CIR NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7827
Practice Address - Country:US
Practice Address - Phone:505-265-5168
Practice Address - Fax:505-265-5168
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist