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NPI Code Detail

MEDICARE: JAMES T WANG MD INC

MEDICARE: JAMES T WANG MD INC
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
1291U00000XClinical Medical Laboratory05D1021032CA
2207N00000XDermatology PhysicianG79462CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C2548617OTHERCACALIFORNIA CORPORATION NUMBER

General Provider Information

NPI Number : 1366645145
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMES T WANG MD INC
Provider Business Mailing Address
First Line : 29833 SANTA MARGARITA PKWY
Second Line : SUITE 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 : SUITE 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 : OWNER
Name : JAMES T WANG
Credential : MD
Telephone Number : 949-888-9288
Provider Enumeration Date : 06/07/2007
Last Update Date : 03/22/2021

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