Provider Demographics
NPI:1497751473
Name:WANG, MICHAEL CHUN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHUN
Last Name:WANG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16809 RUFF DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5630
Mailing Address - Country:US
Mailing Address - Phone:626-961-6889
Mailing Address - Fax:626-968-6629
Practice Address - Street 1:1260 HAMNER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3136
Practice Address - Country:US
Practice Address - Phone:951-808-8320
Practice Address - Fax:951-808-8313
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26509111N00000X
CAAC9069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26509OtherBLUE CROSS-CHIROPRACTIC
CAAC9069OtherBLUE CROSS-ACUPUNCTURE
CADC0265090Medicare ID - Type UnspecifiedNORTHERN CALIFORNIA
CAU99302Medicare UPIN