Provider Demographics
NPI:1073794368
Name:WANG, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:TSU-RIN
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2840 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 435
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1516
Mailing Address - Country:US
Mailing Address - Phone:562-988-8787
Mailing Address - Fax:562-988-8780
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:SUITE 435
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-988-8787
Practice Address - Fax:562-988-8780
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81232207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G812320Medicaid
CAG81232Medicare PIN
CA00G812320Medicaid