Provider Demographics
NPI:1053530360
Name:WANGS MEDICAL GROUP A PROFESSIONAL CORP
Entity type:Organization
Organization Name:WANGS MEDICAL GROUP A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-713-0491
Mailing Address - Street 1:1108 W VALLEY BLVD # 666
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2477
Mailing Address - Country:US
Mailing Address - Phone:213-713-0491
Mailing Address - Fax:213-633-4778
Practice Address - Street 1:1108 W VALLEY BLVD # 666
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2477
Practice Address - Country:US
Practice Address - Phone:213-713-0491
Practice Address - Fax:213-633-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP30001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15696Medicare ID - Type Unspecified