Provider Demographics
NPI:1043107337
Name:WANG, DONG (LAC, MD, PHD)
Entity type:Individual
Prefix:
First Name:DONG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LAC, MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 N 71ST PL STE 1
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6702
Mailing Address - Country:US
Mailing Address - Phone:480-331-9568
Mailing Address - Fax:
Practice Address - Street 1:10630 N 71ST PL STE 1
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6702
Practice Address - Country:US
Practice Address - Phone:480-331-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ012219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty