Provider Demographics
NPI:1437665304
Name:WANG, HAO (PHD, L AC)
Entity type:Individual
Prefix:
First Name:HAO
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 TRIVERTON PIKE DR STE 128
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5841
Mailing Address - Country:US
Mailing Address - Phone:608-957-9677
Mailing Address - Fax:
Practice Address - Street 1:2984 TRIVERTON PIKE DR STE 128
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5841
Practice Address - Country:US
Practice Address - Phone:608-957-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI737-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist