Provider Demographics
NPI:1629109038
Name:WANG, SHIULAN (LAC)
Entity Type:Individual
Prefix:
First Name:SHIULAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91358-0828
Mailing Address - Country:US
Mailing Address - Phone:805-807-9068
Mailing Address - Fax:
Practice Address - Street 1:13088 SLEEPY WIND ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2930
Practice Address - Country:US
Practice Address - Phone:805-807-9068
Practice Address - Fax:805-529-1680
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0009380OtherBLUE SHIELD OF CALIFORNIA