Healthcare Provider Details

I. General information

NPI: 1801403688
Provider Name (Legal Business Name): DR. JIA-CHI WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

1500 DUARTE RD
DUARTE CA
91010-3012
US

V. Phone/Fax

Practice location:
  • Phone: 626-218-3896
  • Fax: 626-218-8877
Mailing address:
  • Phone: 626-218-3896
  • Fax: 626-218-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberDRM-01007329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: