Provider Demographics
NPI:1881094183
Name:WANG, LIFAN
Entity type:Individual
Prefix:
First Name:LIFAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LIFAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1601 W REDONDO BEACH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3244
Mailing Address - Country:US
Mailing Address - Phone:310-715-6836
Mailing Address - Fax:
Practice Address - Street 1:1601 W REDONDO BEACH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3244
Practice Address - Country:US
Practice Address - Phone:310-715-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist