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General NPI Number Information
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NPI Number | 1508119157
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Entity Type | Organization
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Legal Business Name | STEWART WANG MD INC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 440 N MOUNTAIN AVE SUITE 307
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City | UPLAND
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State | CA
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Zip | 91786-5183
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Country | US
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Telephone | 909-985-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 440 N MOUNTAIN AVE SUITE 307
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City | UPLAND
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State | CA
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Zip | 91786-5183
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Country | US
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Telephone | 909-985-6513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEWART WANG
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Credential |
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Telephone | 909-985-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G85318
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License Number State | CA
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