Provider Demographics
NPI:1780572420
Name:WANG, JINGHAN (LAC)
Entity type:Individual
Prefix:
First Name:JINGHAN
Middle Name:
Last Name:WANG
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 1:60 MIHALAKIS ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8902
Mailing Address - Country:US
Mailing Address - Phone:408-477-4402
Mailing Address - Fax:
Practice Address - Street 1:60 MIHALAKIS ST UNIT 402
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8902
Practice Address - Country:US
Practice Address - Phone:408-477-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty