Provider Demographics
NPI:1609683135
Name:WANG, AMY (DTCM)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WATERLILY LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-2892
Mailing Address - Country:US
Mailing Address - Phone:415-595-4829
Mailing Address - Fax:
Practice Address - Street 1:555 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2515
Practice Address - Country:US
Practice Address - Phone:415-595-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20237171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist