Healthcare Provider Details

I. General information

NPI: 1720991524
Provider Name (Legal Business Name): AO XUE WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 300
LOS ANGELES CA
90017-3904
US

IV. Provider business mailing address

2440 HIGHLAND RD
UPLAND CA
91784-1160
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-1295
  • Fax:
Mailing address:
  • Phone: 626-500-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: