Provider Demographics
NPI:1497769012
Name:WANG, ON (MD)
Entity Type:Individual
Prefix:DR
First Name:ON
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 CESAR E CHAVEZ AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2464
Mailing Address - Country:US
Mailing Address - Phone:818-504-7265
Mailing Address - Fax:818-504-1623
Practice Address - Street 1:1701 CESAR E CHAVEZ AVE
Practice Address - Street 2:STE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2464
Practice Address - Country:US
Practice Address - Phone:818-504-7265
Practice Address - Fax:818-504-1623
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70368208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G703680Medicaid
CAWG70368BMedicare ID - Type Unspecified
CA00G703680Medicaid