=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528246881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XIAOGUANG WANG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2008
-----------------------------------------------------
Last Update Date | 06/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7774 CHERRY AVE
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92336-4014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-880-6400
-----------------------------------------------------
Fax | 909-880-6445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7774 CHERRY AVE
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92336-4014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-880-6400
-----------------------------------------------------
Fax | 909-880-6445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | A118779
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | A118779
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------