Healthcare Provider Details

I. General information

NPI: 1922293174
Provider Name (Legal Business Name): PETER K WANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 GARDEN GROVE BLVD STE 306
GARDEN GROVE CA
92843-1904
US

IV. Provider business mailing address

12555 GARDEN GROVE BLVD STE 306
GARDEN GROVE CA
92843-1904
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-0511
  • Fax: 714-537-0418
Mailing address:
  • Phone: 714-537-0511
  • Fax: 714-537-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER K WANG
Title or Position: OWNER
Credential: MD
Phone: 714-537-0511