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NPI Code Detail

MEDICARE: YAN WANG MD

MEDICARE: YAN WANG MD
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
1207ZC0500XCytopathology PhysicianA76292CA
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianA76292CA

General Provider Information

NPI Number : 1063472827
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAN WANG MD
Provider Business Mailing Address
First Line : PO BOX 10076
Second Line :
City : VAN NUYS
State : CA
Zip : 91410-0076
Country : US
Telephone Number : 805-578-8300
Fax Number : 805-578-8950
Provider Business Practice Location Address
First Line : 250 S GRAND AVE
Second Line :
City : GLENDORA
State : CA
Zip : 91741-4218
Country : US
Telephone Number : 626-857-3120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 11/16/2009

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