Provider Demographics
NPI:1497942353
Name:WANG, DOROTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-204-4111
Mailing Address - Fax:310-204-4474
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-204-4111
Practice Address - Fax:310-204-4474
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86810207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FA716AMedicare PIN