Provider Demographics
NPI:1487999322
Name:WANG, SHINSHAN (ND)
Entity type:Individual
Prefix:
First Name:SHINSHAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20687 AMAR RD
Mailing Address - Street 2:SUITE 251
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5044
Mailing Address - Country:US
Mailing Address - Phone:909-803-7012
Mailing Address - Fax:
Practice Address - Street 1:1730 HUNTINGTON DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4878
Practice Address - Country:US
Practice Address - Phone:626-808-4365
Practice Address - Fax:855-802-6293
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-558175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath