Provider Demographics
NPI:1205993284
Name:WANG, SHI JUN
Entity type:Individual
Prefix:MR
First Name:SHI
Middle Name:JUN
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 S ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5256
Mailing Address - Country:US
Mailing Address - Phone:408-309-3877
Mailing Address - Fax:
Practice Address - Street 1:374 S ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5256
Practice Address - Country:US
Practice Address - Phone:408-309-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8516171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist