Provider Demographics
NPI:1740587195
Name:CHAN, GLORIA WAN HANG (LAC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:WAN HANG
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STONERIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-8303
Mailing Address - Country:US
Mailing Address - Phone:828-989-3270
Mailing Address - Fax:
Practice Address - Street 1:201 STONERIDGE BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-8303
Practice Address - Country:US
Practice Address - Phone:828-989-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist