Healthcare Provider Details

I. General information

NPI: 1447909858
Provider Name (Legal Business Name): WAYNE KUANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12675 LA MIRADA BLVD STE 401
LA MIRADA CA
90638-2236
US

IV. Provider business mailing address

12675 LA MIRADA BLVD STE 401
LA MIRADA CA
90638-2236
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5435
  • Fax:
Mailing address:
  • Phone: 562-789-5435
  • Fax: 562-789-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A21639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: