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NPI Code Detail

MEDICARE: DR. LI JUNG WANG O.D.

MEDICARE: DR. LI JUNG WANG O.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
1152W00000XOptometrist12375CA

General Provider Information

NPI Number : 1235444605
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LI JUNG WANG O.D.
Provider Business Mailing Address
First Line : 1713 N PALM AVE
Second Line :
City : UPLAND
State : CA
Zip : 91784-1957
Country : US
Telephone Number : 951-704-6358
Fax Number :
Provider Business Practice Location Address
First Line : 3200 INLAND EMPIRE BLVD STE 140
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5569
Country : US
Telephone Number : 800-805-2737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2010
Last Update Date : 08/10/2010

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