MEDICARE: JAMES T WANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	G79462	CA
2	207ND0900X	Dermatopathology Physician	G79462	CA
3	207NP0225X	Pediatric Dermatology Physician	G79462	CA
4	207NS0135X	Procedural Dermatology Physician	G79462	CA
5	207N00000X	Dermatology Physician	G79462	CA

General Provider Information

NPI Number	:	1013091396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES T WANG M.D.

Provider Business Mailing Address
First Line	:	29833 SANTA MARGARITA PKWY
Second Line	:	100
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-3619
Country	:	US
Telephone Number	:	949-888-9288
Fax Number	:	949-888-8918

Provider Business Practice Location Address
First Line	:	29833 SANTA MARGARITA PKWY
Second Line	:	100
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-3619
Country	:	US
Telephone Number	:	949-888-9288
Fax Number	:	949-888-8918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/22/2021

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