Provider Demographics
NPI:1679531842
Name:LINDA T. WANG M.D., INC
Entity type:Organization
Organization Name:LINDA T. WANG M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-988-8787
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-988-8787
Mailing Address - Fax:562-988-8780
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:SUITE 308
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:562-988-8787
Practice Address - Fax:562-988-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81232207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G812320Medicaid
CAW22135Medicare PIN
CA00G812320Medicaid