Provider Demographics
NPI:1104095330
Name:WANG, KUO TSAN JASON (LA-C)
Entity type:Individual
Prefix:
First Name:KUO TSAN
Middle Name:JASON
Last Name:WANG
Suffix:
Gender:M
Credentials:LA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 SHENADO LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-3332
Mailing Address - Country:US
Mailing Address - Phone:408-872-4657
Mailing Address - Fax:
Practice Address - Street 1:5306 SHENADO LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-3332
Practice Address - Country:US
Practice Address - Phone:408-872-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist