Provider Demographics
NPI:1437270014
Name:JAW J WANG MD INC.
Entity Type:Organization
Organization Name:JAW J WANG MD INC.
Other - Org Name:MONTEBELLO PEDIATRIC MEDICAL GPROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAW
Authorized Official - Middle Name:JIANG
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-726-1400
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-726-1400
Mailing Address - Fax:323-726-2446
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-726-1400
Practice Address - Fax:323-726-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26671208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77724ZMedicaid
CAZZZ77724ZMedicaid