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General NPI Number Information
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NPI Number | 1922111863
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Entity Type | Individual
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Provider Name | MARILENE BETH WANG MD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLAZA #550
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City | LOS ANGELES
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State | CA
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Zip | 90095
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Country | US
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Telephone | 310-206-6688
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Fax | 310-206-4105
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE # 200
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City | LOS ANGELES
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State | CA
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Zip | 90045-5632
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Country | US
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Telephone | 310-206-6688
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Fax | 310-206-4105
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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 | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number | G60942
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G60942
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License Number State | CA
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