Provider Demographics
NPI:1114028404
Name:WANG, ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ALAMEDA ST
Mailing Address - Street 2:#418
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3927
Mailing Address - Country:US
Mailing Address - Phone:310-346-9888
Mailing Address - Fax:
Practice Address - Street 1:545 S ALVARADO ST
Practice Address - Street 2:UNIT D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2903
Practice Address - Country:US
Practice Address - Phone:213-483-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA89518BMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION
CAI40247Medicare UPIN