Provider Demographics
NPI:1851957690
Name:WANG, YA HUI MIRADA
Entity Type:Individual
Prefix:
First Name:YA HUI
Middle Name:MIRADA
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:YA HUI
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3766 LETICIA ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4822
Mailing Address - Country:US
Mailing Address - Phone:626-758-0152
Mailing Address - Fax:
Practice Address - Street 1:3766 LETICIA ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4822
Practice Address - Country:US
Practice Address - Phone:626-758-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty