Healthcare Provider Details

I. General information

NPI: 1578202339
Provider Name (Legal Business Name): YAWEN WANG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 710
ANAHEIM CA
92801-2814
US

IV. Provider business mailing address

1211 W LA PALMA AVE STE 710
ANAHEIM CA
92801-2814
US

V. Phone/Fax

Practice location:
  • Phone: 657-888-9199
  • Fax: 657-888-9179
Mailing address:
  • Phone: 657-888-9199
  • Fax: 657-888-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: YAWEN WANG
Title or Position: PRESIDENT
Credential: MD
Phone: 617-390-4298