Provider Demographics
NPI:1679367031
Name:WANG, JADEN (LAC)
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:
Last Name:WANG
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 RILEIGH LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6582
Mailing Address - Country:US
Mailing Address - Phone:206-465-9339
Mailing Address - Fax:
Practice Address - Street 1:2401 CALLENDER RD STE 103
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8869
Practice Address - Country:US
Practice Address - Phone:817-592-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist