Provider Demographics
NPI:1083269013
Name:WAN, HO MAN HOMAN (ATC)
Entity Type:Individual
Prefix:
First Name:HO MAN HOMAN
Middle Name:
Last Name:WAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:WAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:1140 W PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-3105
Practice Address - Country:US
Practice Address - Phone:702-346-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer