Provider Demographics
NPI:1588678130
Name:WANG, JAMES C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:8436 W 3RD ST STE 603
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4163
Mailing Address - Country:US
Mailing Address - Phone:310-746-5918
Mailing Address - Fax:323-433-7016
Practice Address - Street 1:8436 W 3RD ST STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4100
Practice Address - Country:US
Practice Address - Phone:310-746-5918
Practice Address - Fax:323-433-7016
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3910213EP1101X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU43409Medicare UPIN
CAWE3910AMedicare ID - Type UnspecifiedPPIN #