Provider Demographics
NPI:1790852390
Name:WANG, YUYAN (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:YUYAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:Y
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LAC
Mailing Address - Street 1:301 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5431
Mailing Address - Country:US
Mailing Address - Phone:607-275-9697
Mailing Address - Fax:607-697-0153
Practice Address - Street 1:301 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5431
Practice Address - Country:US
Practice Address - Phone:607-275-9697
Practice Address - Fax:607-697-0153
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000433OtherACUPUNCTURE LICENSE #