Healthcare Provider Details

I. General information

NPI: 1235300989
Provider Name (Legal Business Name): TOMMY J WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DRIVE CITY TOWER #800 ZOT 4482
ORANGE CA
92868
US

IV. Provider business mailing address

488 E OCEAN BLVD UNIT 1202
LONG BEACH CA
90802-4778
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5631
  • Fax: 714-456-6660
Mailing address:
  • Phone: 562-472-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: