Provider Demographics
NPI:1386972149
Name:WANG, ANXI (LAC)
Entity type:Individual
Prefix:MR
First Name:ANXI
Middle Name:
Last Name:WANG
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 1:7900 RITCHIE HWY
Mailing Address - Street 2:D119
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4367
Mailing Address - Country:US
Mailing Address - Phone:443-824-0699
Mailing Address - Fax:
Practice Address - Street 1:7900 RITCHIE HWY
Practice Address - Street 2:D119
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4367
Practice Address - Country:US
Practice Address - Phone:443-824-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00631171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist