Provider Demographics
NPI:1609935345
Name:WANG, WILLIAM (OMD PHD LAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:OMD PHD LAC
Other - Prefix:
Other - First Name:XIAO
Other - Middle Name:HONG
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1173 C S DEANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129
Mailing Address - Country:US
Mailing Address - Phone:408-252-8017
Mailing Address - Fax:408-252-2998
Practice Address - Street 1:1173 C S DEANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129
Practice Address - Country:US
Practice Address - Phone:408-252-8017
Practice Address - Fax:408-252-2998
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist