Provider Demographics
NPI:1366645145
Name:JAMES T WANG MD INC
Entity Type:Organization
Organization Name:JAMES T WANG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-888-9288
Mailing Address - Street 1:29833 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3619
Mailing Address - Country:US
Mailing Address - Phone:949-888-9288
Mailing Address - Fax:949-888-8918
Practice Address - Street 1:29833 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3619
Practice Address - Country:US
Practice Address - Phone:949-888-9288
Practice Address - Fax:949-888-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79462207N00000X
CA05D1021032291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC2548617OtherCALIFORNIA CORPORATION NUMBER