Provider Demographics
NPI:1245234996
Name:WAI, SAN SAN (MD,FACP,MBBS)
Entity Type:Individual
Prefix:DR
First Name:SAN
Middle Name:SAN
Last Name:WAI
Suffix:
Gender:F
Credentials:MD,FACP,MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W MAGNOLIA BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1762
Mailing Address - Country:US
Mailing Address - Phone:818-391-1028
Mailing Address - Fax:818-391-1037
Practice Address - Street 1:2211 W MAGNOLIA BLVD
Practice Address - Street 2:STE 230
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1762
Practice Address - Country:US
Practice Address - Phone:818-391-1028
Practice Address - Fax:818-391-1037
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine