Provider Demographics
NPI:1194740134
Name:WANG, JEAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E DUARTE RD
Mailing Address - Street 2:A
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3993
Mailing Address - Country:US
Mailing Address - Phone:626-445-9088
Mailing Address - Fax:626-445-0288
Practice Address - Street 1:145 E DUARTE RD
Practice Address - Street 2:A
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3993
Practice Address - Country:US
Practice Address - Phone:626-445-9088
Practice Address - Fax:626-445-0288
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor