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General NPI Number Information
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NPI Number | 1699924894
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Entity Type | Individual
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Provider Name | SU WANG PT, DPT, OCS, CSCS
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 853 W 17TH ST STE A
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City | COSTA MESA
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State | CA
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Zip | 92627-4364
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Country | US
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Telephone | 949-423-7077
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Fax | 949-423-7338
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Provider Business Mailing Address
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Address Line | PO BOX 674
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-0674
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Country | US
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Telephone | 949-423-7077
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Fax | 949-423-7338
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT34847
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License Number State | CA
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