Samuel Wang, L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

CA1592 Issued in CA

Practice address

824 5TH Ave Rear C
San Rafael, CA 94901-3257

Phone

(415) 485-5834

Fax

(415) 456-2636

NPI assigned

Oct 19, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Acupuncture Herbal Center

  • Acupuncturist
  • San Rafael, CA
  • NPI 1659817419
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350604800000",
    "number": "1033462668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 5TH AVE REAR C",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013257",
            "telephone_number": "415-485-5834",
            "fax_number": "415-456-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 5TH AVE REAR C",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013257",
            "telephone_number": "415-485-5834",
            "fax_number": "415-456-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "SAMUEL",
        "credential": "L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-19",
        "last_updated": "2012-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "CA1592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L.AC.",
            "identifier": "942971531",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myron Walters, MFT
• Samuel J. Walters, MD
• Zoe Walton, L.AC
• Lai Ping Atalanta Wan, RN, CNS
• Marissa Wang, DMD
• Wilson Wang, MD
• Tashi Wangdu, RPH
• Anne M. Wara, MD
• Karen Ward
• Anne J. Wardell, R.PH.

• Acupuncturist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.