Provider Demographics
NPI:1528517612
Name:WANG, JOHN XINGGANG (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:XINGGANG
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 1:3420 PARSONS BLVD APT 6J
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4609
Mailing Address - Country:US
Mailing Address - Phone:718-755-6637
Mailing Address - Fax:
Practice Address - Street 1:3420 PARSONS BLVD APT 6J
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4609
Practice Address - Country:US
Practice Address - Phone:718-755-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005837171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist