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General NPI Number Information
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NPI Number | 1982651485
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Entity Type | Organization
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Legal Business Name | MICHAEL WAN, M.D., F.A.C.O.G.
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11100 WARNER AVE 150B
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 714-546-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 11100 WARNER AVE 150B
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 714-546-6600
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Fax |
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Authorized Official
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Title or Position | OBSTETRICS AND GYNECOLOGY
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Name | DR. MICHAEL WAN
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Credential | M.D.
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Telephone | 714-546-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | A36431
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License Number State | CA
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