Provider Demographics
NPI:1578202339
Name:YAWEN WANG, M.D., INC.
Entity Type:Organization
Organization Name:YAWEN WANG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-390-4298
Mailing Address - Street 1:1211 W LA PALMA AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2814
Mailing Address - Country:US
Mailing Address - Phone:657-888-9199
Mailing Address - Fax:657-888-9179
Practice Address - Street 1:1211 W LA PALMA AVE STE 710
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2814
Practice Address - Country:US
Practice Address - Phone:657-888-9199
Practice Address - Fax:657-888-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty