Healthcare Provider Details

I. General information

NPI: 1386831139
Provider Name (Legal Business Name): YI WANG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20651 GOLDEN SPRINGS DR SUITE 300
WALNUT CA
91789-3866
US

IV. Provider business mailing address

20651 GOLDEN SPRINGS DR SUITE 300
WALNUT CA
91789-3866
US

V. Phone/Fax

Practice location:
  • Phone: 626-715-7575
  • Fax: 909-594-0696
Mailing address:
  • Phone: 626-715-7575
  • Fax: 909-594-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA98547
License Number StateCA

VIII. Authorized Official

Name: YI WANG
Title or Position: CEO
Credential: M.D.
Phone: 626-715-7575