Healthcare Provider Details

I. General information

NPI: 1023034568
Provider Name (Legal Business Name): WANG TENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR SUITE 350
LAGUNA HILLS CA
92653-3651
US

IV. Provider business mailing address

24411 HEALTH CENTER DR SUITE 350
LAGUNA HILLS CA
92653-3651
US

V. Phone/Fax

Practice location:
  • Phone: 949-457-7900
  • Fax: 949-588-8719
Mailing address:
  • Phone: 949-457-7900
  • Fax: 949-588-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA75686
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA75686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: