Provider Demographics
NPI:1629209549
Name:WANG, LING
Entity Type:Individual
Prefix:
First Name:LING
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:LING
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 LANSING CIR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3974
Mailing Address - Country:US
Mailing Address - Phone:707-751-1966
Mailing Address - Fax:707-751-1966
Practice Address - Street 1:512 LANSING CIR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3974
Practice Address - Country:US
Practice Address - Phone:707-751-1966
Practice Address - Fax:707-751-1966
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist