Healthcare Provider Details

I. General information

NPI: 1649425158
Provider Name (Legal Business Name): ZIQING VICTOR WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 VERMONT AVE
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

25825 VERMONT AVE PARKVIEW BUILDIN
HARBOR CITY CA
90710-3518
US

V. Phone/Fax

Practice location:
  • Phone: 424-328-2638
  • Fax:
Mailing address:
  • Phone: 424-328-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA106032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA106032
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA106032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: