Healthcare Provider Details

I. General information

NPI: 1740717875
Provider Name (Legal Business Name): TIFFANY WANG GENOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/27/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY STE 128
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

9449 IMPERIAL HWY STE 128
DOWNEY CA
90242-2814
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number91743
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number191022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: