Provider Demographics
NPI:1639385149
Name:WANG, YING (LAC,OMD)
Entity Type:Individual
Prefix:DR
First Name:YING
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC,OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 N COLE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7371
Mailing Address - Country:US
Mailing Address - Phone:208-373-5888
Mailing Address - Fax:
Practice Address - Street 1:2304 N COLE RD
Practice Address - Street 2:SUITE D
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7371
Practice Address - Country:US
Practice Address - Phone:208-373-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-142171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist