Provider Demographics
NPI:1285813998
Name:WANG, BEN (LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16769 BERNARDO CENTER DR # K-25
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2546
Mailing Address - Country:US
Mailing Address - Phone:858-451-6668
Mailing Address - Fax:858-451-9799
Practice Address - Street 1:16769 BERNARDO CENTER DR # K-25
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2546
Practice Address - Country:US
Practice Address - Phone:858-451-6668
Practice Address - Fax:858-451-9799
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2552171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist