Healthcare Provider Details

I. General information

NPI: 1184588998
Provider Name (Legal Business Name): IGNATIA TERESA WANG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 PACIFIC COAST HWY
SEAL BEACH CA
90740-6214
US

IV. Provider business mailing address

12664 CHAPMAN AVE UNIT 1313
GARDEN GROVE CA
92840-4031
US

V. Phone/Fax

Practice location:
  • Phone: 562-598-5500
  • Fax:
Mailing address:
  • Phone: 818-480-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number309111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: