Provider Demographics
NPI:1770957169
Name:WANG, YONGJIAN
Entity type:Individual
Prefix:MR
First Name:YONGJIAN
Middle Name:
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 1:35 PRAIRIE LANDING CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4375
Mailing Address - Country:US
Mailing Address - Phone:240-489-1818
Mailing Address - Fax:
Practice Address - Street 1:14812 PHYSICIANS LN
Practice Address - Street 2:162
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3943
Practice Address - Country:US
Practice Address - Phone:240-489-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU00526OtherSTATE OF MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE