Healthcare Provider Details

I. General information

NPI: 1982800249
Provider Name (Legal Business Name): JAMES NIEN CHIN WANG, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N GARFIELD AVE SUITE B
ALHAMBRA CA
91801-3555
US

IV. Provider business mailing address

103 N GARFIELD AVE SUITE B
ALHAMBRA CA
91801-3555
US

V. Phone/Fax

Practice location:
  • Phone: 626-284-7788
  • Fax: 626-284-6255
Mailing address:
  • Phone: 626-284-7788
  • Fax: 626-284-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8055
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG66648
License Number StateCA

VIII. Authorized Official

Name: JAMES N WANG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 626-284-7788