Provider Demographics
NPI:1770788846
Name:TIAN, WEN (LICAC)
Entity type:Individual
Prefix:MS
First Name:WEN
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:TIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICAC
Mailing Address - Street 1:15 HUTCHINS CIR
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1736
Mailing Address - Country:US
Mailing Address - Phone:617-816-3698
Mailing Address - Fax:
Practice Address - Street 1:15 HUTCHINS CIR
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1736
Practice Address - Country:US
Practice Address - Phone:617-816-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist