Provider Demographics
NPI:1417944893
Name:WANG, MINCHEN (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MINCHEN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:DR
Other - First Name:VINCE
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD LAC
Mailing Address - Street 1:3023 BUNKER HILL ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5706
Mailing Address - Country:US
Mailing Address - Phone:858-688-7294
Mailing Address - Fax:858-746-4212
Practice Address - Street 1:3023 BUNKER HILL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5706
Practice Address - Country:US
Practice Address - Phone:858-688-7294
Practice Address - Fax:858-746-4212
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0064560Medicaid