Provider Demographics
NPI:1710150032
Name:WANG, WEI (LAC)
Entity Type:Individual
Prefix:MR
First Name:WEI
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 W HELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1007
Mailing Address - Country:US
Mailing Address - Phone:626-975-1311
Mailing Address - Fax:
Practice Address - Street 1:701 W VALLEY BLVD STE 25
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3245
Practice Address - Country:US
Practice Address - Phone:626-975-1311
Practice Address - Fax:626-576-8883
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12325OtherSTATE