Provider Demographics
NPI:1912534488
Name:WANG, YANFANG (CAMTC)
Entity Type:Individual
Prefix:MRS
First Name:YANFANG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:CAMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 E MARINA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2320
Mailing Address - Country:US
Mailing Address - Phone:562-547-4185
Mailing Address - Fax:
Practice Address - Street 1:8201 WESTMINSTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3332
Practice Address - Country:US
Practice Address - Phone:714-892-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57796225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty