Healthcare Provider Details

I. General information

NPI: 1790063055
Provider Name (Legal Business Name): LING YI WANG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

20 MARYSVILLE
IRVINE CA
92602-1066
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4047
  • Fax: 714-509-4371
Mailing address:
  • Phone: 714-926-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number44058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: