Provider Demographics
NPI:1942048178
Name:WAN, ZHIJING ZW (AC20119)
Entity type:Individual
Prefix:
First Name:ZHIJING
Middle Name:ZW
Last Name:WAN
Suffix:
Gender:F
Credentials:AC20119
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 DAROCA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2929
Mailing Address - Country:US
Mailing Address - Phone:626-487-8662
Mailing Address - Fax:
Practice Address - Street 1:217 DAROCA AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2929
Practice Address - Country:US
Practice Address - Phone:626-487-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist