Provider Demographics
NPI:1225384548
Name:WANG, CHIA-TI (LAC)
Entity Type:Individual
Prefix:
First Name:CHIA-TI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 MAIN ST # B3146
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3823
Mailing Address - Country:US
Mailing Address - Phone:347-453-9165
Mailing Address - Fax:
Practice Address - Street 1:4170 MAIN ST # B3146
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3823
Practice Address - Country:US
Practice Address - Phone:347-453-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004828171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist