Provider Demographics
NPI:1235300989
Name:WANG, TOMMY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:J
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:488 E OCEAN BLVD UNIT 1202
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4778
Mailing Address - Country:US
Mailing Address - Phone:562-472-4769
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DRIVE
Practice Address - Street 2:CITY TOWER #800 ZOT 4482
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-5631
Practice Address - Fax:714-456-6660
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics