Provider Demographics
NPI:1033286430
Name:WANG, CASEY LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:LORRAINE
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MAIL CODE 5008
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5818
Mailing Address - Fax:858-966-7483
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:MAIL CODE 5008
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5818
Practice Address - Fax:858-966-7483
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA80114208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics