Healthcare Provider Details

I. General information

NPI: 1093196560
Provider Name (Legal Business Name): STEVEN HENGCHIH WANG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ODYSSEY STE 150
IRVINE CA
92618-3196
US

IV. Provider business mailing address

24 APRILLA
IRVINE CA
92614-0229
US

V. Phone/Fax

Practice location:
  • Phone: 949-733-3390
  • Fax: 949-461-1461
Mailing address:
  • Phone: 714-209-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: