Provider Demographics
NPI:1083292510
Name:LING, WAN STEPHEN
Entity Type:Individual
Prefix:
First Name:WAN STEPHEN
Middle Name:
Last Name:LING
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 1:3763 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2939
Mailing Address - Country:US
Mailing Address - Phone:408-609-7627
Mailing Address - Fax:
Practice Address - Street 1:3763 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2939
Practice Address - Country:US
Practice Address - Phone:408-609-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist