Provider Demographics
NPI:1023683026
Name:WANG, YIMING (LAC)
Entity type:Individual
Prefix:MRS
First Name:YIMING
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18170 DALLAS PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7148
Mailing Address - Country:US
Mailing Address - Phone:972-680-0121
Mailing Address - Fax:972-680-0121
Practice Address - Street 1:18170 DALLAS PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7148
Practice Address - Country:US
Practice Address - Phone:972-680-0121
Practice Address - Fax:972-680-0121
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist