Healthcare Provider Details

I. General information

NPI: 1558624072
Provider Name (Legal Business Name): GLORIA YEEFEN WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number281635
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA140555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: