Healthcare Provider Details

I. General information

NPI: 1922263979
Provider Name (Legal Business Name): ANDY CHUNYAO WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-3826
  • Fax:
Mailing address:
  • Phone: 626-353-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD443417
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC170961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: