Provider Demographics
NPI:1235293648
Name:WANG, ROBERT T (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:WANG
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:#301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4664
Mailing Address - Country:US
Mailing Address - Phone:323-931-3100
Mailing Address - Fax:323-931-0030
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:#301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4664
Practice Address - Country:US
Practice Address - Phone:323-931-3100
Practice Address - Fax:323-931-0030
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG40989207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9745630Medicaid
CAGR0079630OtherMEDICAL GRP NUMBER
CA38000043OtherRAILROAD MCR
CA38000043OtherRAILROAD MCR
CAW11213Medicare ID - Type Unspecified