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General NPI Number Information
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NPI Number | 1285030189
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Entity Type | Individual
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Provider Name | LORRAINE CF WANG
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 400 W 30TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90007-3320
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Country | US
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Telephone | 909-272-7782
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Fax |
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Provider Business Mailing Address
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Address Line | 226 BENICIA RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1601
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Country | US
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Telephone | 909-272-7782
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA52930
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License Number State | CA
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