Healthcare Provider Details

I. General information

NPI: 1124322052
Provider Name (Legal Business Name): SONNY S. WANG, M.D. COLON AND RECTAL SURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR SUITE 306
IRVINE CA
92618-3164
US

IV. Provider business mailing address

18 ENDEAVOR SUITE 306
IRVINE CA
92618-3164
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-7240
  • Fax: 949-387-7219
Mailing address:
  • Phone: 949-387-7240
  • Fax: 949-387-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA81551
License Number StateCA

VIII. Authorized Official

Name: DR. SONNY SHENG-HUNG WANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-387-7240