Provider Demographics
NPI:1477067403
Name:WANG- CASTUERA, MEISHAN FAN
Entity Type:Individual
Prefix:
First Name:MEISHAN
Middle Name:FAN
Last Name:WANG- CASTUERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6138 ROSEMEAD BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1564
Mailing Address - Country:US
Mailing Address - Phone:626-487-0188
Mailing Address - Fax:
Practice Address - Street 1:542 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3304
Practice Address - Country:US
Practice Address - Phone:626-487-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16558171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist