Provider Demographics
NPI:1336291418
Name:WANG, HONG (LAC)
Entity Type:Individual
Prefix:DR
First Name:HONG
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 1:18043 PIONEER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3904
Mailing Address - Country:US
Mailing Address - Phone:562-924-3260
Mailing Address - Fax:
Practice Address - Street 1:18043 PIONEER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3904
Practice Address - Country:US
Practice Address - Phone:562-924-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5081171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0050810Medicaid