Provider Demographics
NPI:1558493502
Name:WANG, JIANLI (ND, LAC)
Entity Type:Individual
Prefix:
First Name:JIANLI
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 196TH ST SW
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6123
Mailing Address - Country:US
Mailing Address - Phone:425-672-2838
Mailing Address - Fax:425-672-2988
Practice Address - Street 1:5017 196TH ST SW
Practice Address - Street 2:SUITE 206
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6123
Practice Address - Country:US
Practice Address - Phone:425-672-2838
Practice Address - Fax:425-672-2988
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA382171100000X
WA1016175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath