MEDICARE: SHUO S. WANG M.D. 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
1	207R00000X	Internal Medicine Physician	A76144	CA

General Provider Information

NPI Number	:	1497994420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHUO S. WANG M.D. INC.

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-0010
Country	:	US
Telephone Number	:	213-261-0889
Fax Number	:	213-628-1012

Provider Business Practice Location Address
First Line	:	711 W COLLEGE ST STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1093
Country	:	US
Telephone Number	:	213-261-0889
Fax Number	:	213-628-1012

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANGELA MONTOYA
Credential	:
Telephone Number	:	213-261-0889

Provider Enumeration Date	:	02/15/2009
Last Update Date	:	09/13/2013

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