Provider Demographics
NPI:1083717581
Name:WANG, ZHAO (OMD)
Entity Type:Individual
Prefix:MR
First Name:ZHAO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 W BROADWAY
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1109
Mailing Address - Country:US
Mailing Address - Phone:714-956-9168
Mailing Address - Fax:714-956-0200
Practice Address - Street 1:1673 W BROADWAY
Practice Address - Street 2:SUITE 5B
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1109
Practice Address - Country:US
Practice Address - Phone:714-956-9168
Practice Address - Fax:714-956-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4552171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist