Provider Demographics
NPI:1619040508
Name:WANG, YAJUAN (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:YAJUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 3RD AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1126
Mailing Address - Country:US
Mailing Address - Phone:206-343-7223
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1126
Practice Address - Country:US
Practice Address - Phone:206-343-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist