Provider Demographics
NPI:1558689638
Name:WANG, CHIA-YING
Entity Type:Individual
Prefix:
First Name:CHIA-YING
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18112 CULVER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2730
Mailing Address - Country:US
Mailing Address - Phone:949-786-0151
Mailing Address - Fax:949-786-8262
Practice Address - Street 1:18112 CULVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2730
Practice Address - Country:US
Practice Address - Phone:949-786-0151
Practice Address - Fax:949-786-8262
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist