Healthcare Provider Details

I. General information

NPI: 1417881780
Provider Name (Legal Business Name): HAOTIAN WANG RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 TIFFIN
IRVINE CA
92618-5937
US

IV. Provider business mailing address

112 TIFFIN
IRVINE CA
92618-5937
US

V. Phone/Fax

Practice location:
  • Phone: 916-291-0999
  • Fax:
Mailing address:
  • Phone: 916-291-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: