Provider Demographics
NPI:1508256579
Name:WANG, DA-GANG (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:DA-GANG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1834
Mailing Address - Country:US
Mailing Address - Phone:415-250-1655
Mailing Address - Fax:
Practice Address - Street 1:1801 BUSH ST STE 120
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5273
Practice Address - Country:US
Practice Address - Phone:415-250-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist