Healthcare Provider Details

I. General information

NPI: 1265362743
Provider Name (Legal Business Name): NAHLA WANG AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 S ROBERTSON BLVD # 100101
LOS ANGELES CA
90035-1605
US

IV. Provider business mailing address

1521 AZURE WAY
ARCADIA CA
91007-4018
US

V. Phone/Fax

Practice location:
  • Phone: 810-224-7703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: