Healthcare Provider Details

I. General information

NPI: 1275191280
Provider Name (Legal Business Name): ARVY WUYSANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON STREET GME OFFICE WESTERLY SUITE 'C'
LOMA LINDA CA
92354-2971
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4174
  • Fax:
Mailing address:
  • Phone: 909-565-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61309806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: