Healthcare Provider Details

I. General information

NPI: 1205005584
Provider Name (Legal Business Name): GEORGE JAW-JEN WANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SANTA ANITA ST STE G18
SAN GABRIEL CA
91776-1147
US

IV. Provider business mailing address

207 S SANTA ANITA ST STE G18
SAN GABRIEL CA
91776-1147
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-8448
  • Fax: 626-768-7585
Mailing address:
  • Phone: 626-389-8448
  • Fax: 626-768-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: