Healthcare Provider Details

I. General information

NPI: 1912013012
Provider Name (Legal Business Name): HANJU WANG APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 4TH ST
LONG BEACH CA
90802-1831
US

IV. Provider business mailing address

1220 E 4TH ST
LONG BEACH CA
90802-1831
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 855-712-7837
Mailing address:
  • Phone: 888-530-4415
  • Fax: 855-712-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277001111
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: