Healthcare Provider Details

I. General information

NPI: 1760748859
Provider Name (Legal Business Name): CHONGHUA WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARL WANG M.D.

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3762 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

IV. Provider business mailing address

3762 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

V. Phone/Fax

Practice location:
  • Phone: 949-414-7246
  • Fax: 949-757-3846
Mailing address:
  • Phone: 949-414-7246
  • Fax: 949-757-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA128621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA128621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: