Provider Demographics
NPI:1629674080
Name:WANG, SENLIN
Entity Type:Individual
Prefix:
First Name:SENLIN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W DUARTE RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7630
Mailing Address - Country:US
Mailing Address - Phone:626-297-8998
Mailing Address - Fax:626-254-1588
Practice Address - Street 1:650 W DUARTE RD STE 100A
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7630
Practice Address - Country:US
Practice Address - Phone:626-297-8998
Practice Address - Fax:626-254-1588
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6918171100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturist