Provider Demographics
NPI:1760529895
Name:WANG, YARONG (AC)
Entity Type:Individual
Prefix:MS
First Name:YARONG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PINE WEST PLZ
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5532
Mailing Address - Country:US
Mailing Address - Phone:518-690-2008
Mailing Address - Fax:
Practice Address - Street 1:2 PINE WEST PLZ WASHINGTON AVE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5532
Practice Address - Country:US
Practice Address - Phone:518-690-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist