Provider Demographics
NPI:1942430723
Name:WANG, QIJIAN (LICAC)
Entity Type:Individual
Prefix:DR
First Name:QIJIAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136-14 NORTHERN BLVD
Mailing Address - Street 2:4J
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6513
Mailing Address - Country:US
Mailing Address - Phone:718-539-3251
Mailing Address - Fax:
Practice Address - Street 1:13614 NORTHERN BLVD
Practice Address - Street 2:4J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6511
Practice Address - Country:US
Practice Address - Phone:718-539-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001687171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist