Healthcare Provider Details

I. General information

NPI: 1982602579
Provider Name (Legal Business Name): ROGER HSIO-HSION WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 17TH ST SUITE W239
SANTA ANA CA
92701-2201
US

IV. Provider business mailing address

1125 E 17TH ST SUITE W239
SANTA ANA CA
92701-2201
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-1818
  • Fax: 714-835-7200
Mailing address:
  • Phone: 714-835-1818
  • Fax: 714-835-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA44667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: