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General NPI Number Information
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NPI Number | 1396778346
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Entity Type | Organization
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Legal Business Name | CHUNG NAN WANG MD INC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3525 LOMA VISTA RD SUITE B
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City | VENTURA
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State | CA
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Zip | 93003-3101
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Country | US
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Telephone | 805-641-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 6073 BRIDGEVIEW DR
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City | VENTURA
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State | CA
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Zip | 93003-1131
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Country | US
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Telephone | 805-644-6600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHUNG NAN WANG
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Credential | MD
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Telephone | 805-642-8565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A31187
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License Number State | CA
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