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General NPI Number Information
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NPI Number | 1700227931
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Entity Type | Individual
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Provider Name | SHIRLEY LEE WANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 1701 E CESAR E CHAVEZ AVE STE 545
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City | LOS ANGELES
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State | CA
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Zip | 90033-2464
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Country | US
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Telephone | 949-689-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 53 FULTON
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City | IRVINE
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State | CA
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Zip | 92620-3349
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Country | US
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Telephone | 949-689-0188
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A142943
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MT205109
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License Number State | PA
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