Provider Demographics
NPI:1588023626
Name:WANG, ROGER XIN (L AC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:XIN
Last Name:WANG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12627 SAN JOSE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8638
Mailing Address - Country:US
Mailing Address - Phone:904-437-5203
Mailing Address - Fax:904-374-5354
Practice Address - Street 1:12627 SAN JOSE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8638
Practice Address - Country:US
Practice Address - Phone:904-437-5203
Practice Address - Fax:904-374-5354
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist