Provider Demographics
NPI:1437586377
Name:WANG, SAM J (LAC)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:J
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:10261 TRADEMARK ST
Mailing Address - Street 2:UNIT # B
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5805
Mailing Address - Country:US
Mailing Address - Phone:213-268-5278
Mailing Address - Fax:909-948-8860
Practice Address - Street 1:10261 TRADEMARK ST
Practice Address - Street 2:UNIT # B
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5805
Practice Address - Country:US
Practice Address - Phone:213-268-5278
Practice Address - Fax:909-948-8860
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2014-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 15365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist