MEDICARE: DR. JENNY ZHUOYUE WANG 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	207N00000X	Dermatology Physician	A179146	CA

General Provider Information

NPI Number	:	1679036719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNY ZHUOYUE WANG MD

Provider Business Mailing Address
First Line	:	12555 W JEFFERSON BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-7047
Country	:	US
Telephone Number	:	424-543-0066
Fax Number	:

Provider Business Practice Location Address
First Line	:	12555 W JEFFERSON BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-7047
Country	:	US
Telephone Number	:	424-543-0066
Fax Number	:

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

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	01/24/2024

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