Provider Demographics
NPI:1417042524
Name:LIU & WANG MEDICAL CORP
Entity Type:Organization
Organization Name:LIU & WANG MEDICAL CORP
Other - Org Name:URGENTCARE MEDICAL CENTER OF ROWLAND HEIGHTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-964-1170
Mailing Address - Street 1:1118 S GARFIELD AVE
Mailing Address - Street 2:#201
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1118 S GARFIELD AVE
Practice Address - Street 2:#201
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4713
Practice Address - Country:US
Practice Address - Phone:626-281-0090
Practice Address - Fax:626-281-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61726207R00000X
CAA61785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR00944201Medicaid
CAW16464Medicare ID - Type Unspecified