Provider Demographics
NPI:1750465142
Name:WANG, YAN (DOM)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3705 WESTERFELD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3462
Mailing Address - Country:US
Mailing Address - Phone:505-299-6299
Mailing Address - Fax:505-299-0149
Practice Address - Street 1:3705 WESTERFELD DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3462
Practice Address - Country:US
Practice Address - Phone:505-299-6299
Practice Address - Fax:505-299-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist