Healthcare Provider Details

I. General information

NPI: 1689073496
Provider Name (Legal Business Name): SONGSONG WANG MSW INTERN STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S. LAFAYETTE PARK PLACE #300
LA CA
90057
US

IV. Provider business mailing address

520 S. LAFAYETTE PARK PLACE #300
LA CA
90057
US

V. Phone/Fax

Practice location:
  • Phone: 213-252-2100
  • Fax: 213-383-3146
Mailing address:
  • Phone: 213-252-2100
  • Fax: 213-383-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: