Provider Demographics
NPI:1013079136
Name:WANG, RONG (LAC DOM)
Entity Type:Individual
Prefix:MRS
First Name:RONG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC DOM
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-0204
Mailing Address - Country:US
Mailing Address - Phone:281-293-9998
Mailing Address - Fax:877-795-9098
Practice Address - Street 1:6430 RICHMOND AVE STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5993
Practice Address - Country:US
Practice Address - Phone:281-293-9998
Practice Address - Fax:877-795-9098
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013079136OtherACUPUNCTURE