MEDICARE: LYNN WANG M.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
1	207R00000X	Internal Medicine Physician	048739	GA
2	207RN0300X	Nephrology Physician	A74029	CA

General Provider Information

NPI Number	:	1598715062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN WANG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1467
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91077-1467
Country	:	US
Telephone Number	:	626-590-9889
Fax Number	:	626-462-0230

Provider Business Practice Location Address
First Line	:	600 N GARFIELD AVE STE 205
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-1169
Country	:	US
Telephone Number	:	626-288-0488
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/08/2020

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