Provider Demographics
NPI:1730915307
Name:WANG, LIYUN (LAC)
Entity type:Individual
Prefix:
First Name:LIYUN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 VAN NUYS BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2125
Mailing Address - Country:US
Mailing Address - Phone:818-386-0629
Mailing Address - Fax:818-386-0891
Practice Address - Street 1:4849 VAN NUYS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2125
Practice Address - Country:US
Practice Address - Phone:818-386-0629
Practice Address - Fax:818-386-0891
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11827171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist