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General NPI Number Information
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NPI Number | 1043515877
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Entity Type | Organization
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Legal Business Name | HOLLY WANG MD INC
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 50 ALESSANDRO PL SUITE 200
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City | PASADENA
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State | CA
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Zip | 91105-3149
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Country | US
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Telephone | 626-696-1234
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Fax | 626-696-1230
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Provider Business Mailing Address
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Address Line | PO BOX 50127
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City | PASADENA
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State | CA
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Zip | 91115-0127
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Country | US
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Telephone | 626-696-1234
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Fax | 626-696-1230
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | EZEKIEL WANG
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Credential |
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Telephone | 626-696-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A69635
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License Number State | CA
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