Provider Demographics
NPI:1285709238
Name:WEN, KUANG YUAN (LAC)
Entity type:Individual
Prefix:MR
First Name:KUANG YUAN
Middle Name:
Last Name:WEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 MOORPARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2076
Mailing Address - Country:US
Mailing Address - Phone:408-646-4153
Mailing Address - Fax:866-889-5168
Practice Address - Street 1:4325 MOORPARK AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2076
Practice Address - Country:US
Practice Address - Phone:408-646-4153
Practice Address - Fax:866-889-5168
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist