Healthcare Provider Details

I. General information

NPI: 1366729709
Provider Name (Legal Business Name): ILING WANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S 3RD AVE
ARCADIA CA
91006-3806
US

IV. Provider business mailing address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 626-353-4315
  • Fax:
Mailing address:
  • Phone: 626-353-4315
  • Fax: 213-427-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number690590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: