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General NPI Number Information
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NPI Number | 1053530360
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Entity Type | Organization
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Legal Business Name | WANGS MEDICAL GROUP A PROFESSIONAL CORP
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1108 W VALLEY BLVD # 666
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City | ALHAMBRA
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State | CA
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Zip | 91803-2477
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Country | US
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Telephone | 213-713-0491
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Fax | 213-633-4778
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Provider Business Mailing Address
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Address Line | 1108 W VALLEY BLVD # 666
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City | ALHAMBRA
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State | CA
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Zip | 91803-2477
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Country | US
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Telephone | 213-713-0491
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Fax | 213-633-4778
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Authorized Official
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Title or Position | PRESIDENT
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Name | XIN WANG
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Credential | M.D.
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Telephone | 213-713-0491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | FNP30001
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License Number State | CA
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