Provider Demographics
NPI:1295856300
Name:WANG, WEIZHANG (LAC)
Entity Type:Individual
Prefix:
First Name:WEIZHANG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 MORNINGSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2932
Mailing Address - Country:US
Mailing Address - Phone:310-392-3335
Mailing Address - Fax:310-392-3335
Practice Address - Street 1:1252 MORNINGSIDE WAY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2932
Practice Address - Country:US
Practice Address - Phone:310-392-3335
Practice Address - Fax:310-392-3335
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist