Healthcare Provider Details

I. General information

NPI: 1306878491
Provider Name (Legal Business Name): STEWART PEY-HSIN WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 N HUDSON AVE STE 100
PASADENA CA
91101-1827
US

IV. Provider business mailing address

76 N HUDSON AVE STE 100
PASADENA CA
91101-1827
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-6513
  • Fax:
Mailing address:
  • Phone: 909-985-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG85318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: