Provider Demographics
NPI:1194987818
Name:WANG, QUN
Entity type:Individual
Prefix:
First Name:QUN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4431
Mailing Address - Country:US
Mailing Address - Phone:352-690-1880
Mailing Address - Fax:352-690-6255
Practice Address - Street 1:528 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4431
Practice Address - Country:US
Practice Address - Phone:352-690-1880
Practice Address - Fax:352-690-6255
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP0000522171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP0000522OtherBLUE CROSS AND BLUE SHIELD INSURANCE C0271