Healthcare Provider Details

I. General information

NPI: 1124414198
Provider Name (Legal Business Name): DAVID WEI WANG, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N GARFIELD AVE SUITE 300
MONTEREY PARK CA
91754-1746
US

IV. Provider business mailing address

210 N GARFIELD AVE SUITE 300
MONTEREY PARK CA
91754-1746
US

V. Phone/Fax

Practice location:
  • Phone: 626-307-9009
  • Fax: 626-307-1807
Mailing address:
  • Phone: 626-307-9009
  • Fax: 626-307-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC37520
License Number StateCA

VIII. Authorized Official

Name: DAVID WEI WANG
Title or Position: PRESIDENT
Credential: MD
Phone: 626-307-9009