Provider Demographics
NPI:1790988020
Name:HE, WAN
Entity Type:Individual
Prefix:
First Name:WAN
Middle Name:
Last Name:HE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 W PAMPAS LANE
Mailing Address - Street 2:APT 3
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1036
Mailing Address - Country:US
Mailing Address - Phone:714-329-3677
Mailing Address - Fax:
Practice Address - Street 1:1655 W PAMPAS LANE
Practice Address - Street 2:APT 3
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1036
Practice Address - Country:US
Practice Address - Phone:714-329-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11443171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist