Provider Demographics
NPI:1780021378
Name:WANG, ZHI PENG (LAC)
Entity Type:Individual
Prefix:
First Name:ZHI PENG
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 1:120 S. DEL MAR AVE.
Mailing Address - Street 2:2176
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-7184
Mailing Address - Country:US
Mailing Address - Phone:626-202-3684
Mailing Address - Fax:
Practice Address - Street 1:1418 S SAN GABRIEL BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-4605
Practice Address - Country:US
Practice Address - Phone:626-202-3684
Practice Address - Fax:626-380-1328
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC14554OtherSTATE