Healthcare Provider Details

I. General information

NPI: 1720155609
Provider Name (Legal Business Name): AMY QIU WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST STE 100-B
GLENDALE CA
91204-2849
US

IV. Provider business mailing address

1043 ELM AVE STE 104
LONG BEACH CA
90813-3271
US

V. Phone/Fax

Practice location:
  • Phone: 818-637-7611
  • Fax: 818-637-5106
Mailing address:
  • Phone: 562-590-0345
  • Fax: 562-437-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA72227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: