MEDICARE: PETER C WANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G84367	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063475242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER C WANG M.D.

Provider Business Mailing Address
First Line	:	510 SUPERIOR AVE
Second Line	:	STE. 200-G
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3663
Country	:	US
Telephone Number	:	949-791-6767
Fax Number	:	949-791-6768

Provider Business Practice Location Address
First Line	:	510 SUPERIOR AVE
Second Line	:	STE. 200-G
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3663
Country	:	US
Telephone Number	:	949-791-6767
Fax Number	:	949-791-6768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/09/2016

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