MEDICARE: DR. SARAH JENNIFER WHANG 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
1	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	C54031	CA
2	207W00000X	Ophthalmology Physician	C54031	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1306841457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH JENNIFER WHANG MD

Provider Business Mailing Address
First Line	:	302 W LA VETA AVE
Second Line	:	STE 101
City	:	ORANGE
State	:	CA
Zip	:	92866-2607
Country	:	US
Telephone Number	:	714-633-0321
Fax Number	:	714-633-9196

Provider Business Practice Location Address
First Line	:	302 W LA VETA AVE
Second Line	:	STE 101
City	:	ORANGE
State	:	CA
Zip	:	92866-2607
Country	:	US
Telephone Number	:	714-633-0321
Fax Number	:	714-633-9196

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/20/2020

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