Healthcare Provider Details

I. General information

NPI: 1629990452
Provider Name (Legal Business Name): HORIZONWAVE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 GLENCOE AVE STE 145
MARINA DEL REY CA
90292-6385
US

IV. Provider business mailing address

13157 MINDANAO WAY STE 201
MARINA DEL REY CA
90292-6307
US

V. Phone/Fax

Practice location:
  • Phone: 310-584-7860
  • Fax:
Mailing address:
  • Phone: 310-584-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIKA JANG
Title or Position: VICE PRESIDENT
Credential:
Phone: 310-437-7929