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General NPI Number Information
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NPI Number | 1174047112
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Entity Type | Individual
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Provider Name | AI WANG
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1525 SAINT ALBANS RD
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City | SAN MARINO
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State | CA
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Zip | 91108-1864
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Country | US
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Telephone | 951-367-5640
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 SAINT ALBANS RD
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City | SAN MARINO
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State | CA
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Zip | 91108-1864
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Country | US
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Telephone | 951-367-5640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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