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NPI Code Detail

MEDICARE: BRIAN WANG

MEDICARE: BRIAN WANG
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1174316814
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN WANG
Provider Business Mailing Address
First Line : 17839 LA LIMA LN
Second Line :
City : FOUNTAIN VALLEY
State : CA
Zip : 92708-5325
Country : US
Telephone Number : 714-717-7253
Fax Number :
Provider Business Practice Location Address
First Line : 4281 KATELLA AVE STE 207
Second Line :
City : LOS ALAMITOS
State : CA
Zip : 90720-6515
Country : US
Telephone Number : 626-270-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2025
Last Update Date : 05/27/2025

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Directions to “ BRIAN WANG ” Practice Location

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