Healthcare Provider Details

I. General information

NPI: 1508662230
Provider Name (Legal Business Name): JOSHUA D WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 DALEN ST
DOWNEY CA
90242-4847
US

IV. Provider business mailing address

507 CELESTIAL PT
TUSTIN CA
92782-1703
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-6059
  • Fax:
Mailing address:
  • Phone: 949-878-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: