Healthcare Provider Details

I. General information

NPI: 1982651485
Provider Name (Legal Business Name): MICHAEL WAN, M.D., F.A.C.O.G.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE 150B
FOUNTAIN VALLEY CA
92708-7506
US

IV. Provider business mailing address

11100 WARNER AVE 150B
FOUNTAIN VALLEY CA
92708-7506
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-6600
  • Fax:
Mailing address:
  • Phone: 714-546-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA36431
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL WAN
Title or Position: OBSTETRICS AND GYNECOLOGY
Credential: M.D.
Phone: 714-546-6600