Provider Demographics
NPI:1811061690
Name:WANG, SHIRLEY XUEHUA (LAC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:XUEHUA
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:XUEHUA
Other - Middle Name:SHIRLEY
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:470 W HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2939
Mailing Address - Country:US
Mailing Address - Phone:817-498-8449
Mailing Address - Fax:817-281-4829
Practice Address - Street 1:470 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2939
Practice Address - Country:US
Practice Address - Phone:817-498-8449
Practice Address - Fax:817-281-4829
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11803644OtherCAQH
TX4594265OtherCIGNA