Provider Demographics
NPI:1235296757
Name:WANG, GUOEN (LAC)
Entity Type:Individual
Prefix:
First Name:GUOEN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11851 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2338
Mailing Address - Country:US
Mailing Address - Phone:512-453-5352
Mailing Address - Fax:512-453-5318
Practice Address - Street 1:11851 JOLLYVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2338
Practice Address - Country:US
Practice Address - Phone:512-453-5352
Practice Address - Fax:512-453-5318
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist