Provider Demographics
NPI:1093710386
Name:WANG, XUEBIN (DC AND LAC)
Entity Type:Individual
Prefix:
First Name:XUEBIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DC AND LAC
Other - Prefix:
Other - First Name:XUEBIN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:22730 HAWTHORNE BLVD #102.
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-328-8898
Mailing Address - Fax:310-787-8889
Practice Address - Street 1:22730 HAWTHORNE BLVD #102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-328-8898
Practice Address - Fax:310-787-8889
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2015-02-20
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CADC21188111N00000X
CAAC3510171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0211880Medicaid
CAAC0035100Medicaid
DC21188Medicare PIN