Healthcare Provider Details

I. General information

NPI: 1215844964
Provider Name (Legal Business Name): HUIYUAN WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5227 HALISON ST
TORRANCE CA
90503-1923
US

IV. Provider business mailing address

5227 HALISON ST
TORRANCE CA
90503-1923
US

V. Phone/Fax

Practice location:
  • Phone: 310-347-5389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95040469
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberNP95040469
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberNP95040469
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP95040469
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95040469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: