Provider Demographics
NPI:1659442762
Name:WANG, JASON (CA, DIPL AC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:CA, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 19TH ST W STE 7
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6223
Mailing Address - Country:US
Mailing Address - Phone:253-581-4111
Mailing Address - Fax:253-581-4111
Practice Address - Street 1:6314 19TH ST W STE 7
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-581-4111
Practice Address - Fax:253-581-4111
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000174171100000X
CAAC2403171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist