Provider Demographics
NPI:1023041423
Name:CHUN YEH WANG MD PHD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHUN YEH WANG MD PHD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN-YEH
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PH D,
Authorized Official - Phone:626-588-1555
Mailing Address - Street 1:416 W LAS TUNAS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1236
Mailing Address - Country:US
Mailing Address - Phone:626-588-1555
Mailing Address - Fax:626-457-5690
Practice Address - Street 1:416 W LAS TUNAS DR STE 306
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1236
Practice Address - Country:US
Practice Address - Phone:626-588-1555
Practice Address - Fax:626-457-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G720650Medicaid
CABQ812AMedicare PIN
CAG58722Medicare UPIN