Provider Demographics
NPI:1326501586
Name:WANG, XICHUN JR (DO)
Entity Type:Individual
Prefix:PROF
First Name:XICHUN
Middle Name:
Last Name:WANG
Suffix:JR
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 STEVENS CREEK BLVD APT 215
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-7604
Mailing Address - Country:US
Mailing Address - Phone:408-858-7466
Mailing Address - Fax:
Practice Address - Street 1:5606 STEVENS CREEK BLVD APT 215
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-7604
Practice Address - Country:US
Practice Address - Phone:408-858-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18484171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist