Provider Demographics
NPI:1669900585
Name:WANG, WEIJUN (LAC)
Entity type:Individual
Prefix:
First Name:WEIJUN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6064 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3329
Mailing Address - Country:US
Mailing Address - Phone:626-716-8285
Mailing Address - Fax:323-442-2072
Practice Address - Street 1:2063 S ATLANTIC BLVD STE 303
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6366
Practice Address - Country:US
Practice Address - Phone:626-716-8285
Practice Address - Fax:323-442-2072
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17656171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty