Provider Demographics
NPI:1639427222
Name:GEORGE H. WANG, M.D. OB/GYN MED CORP
Entity Type:Organization
Organization Name:GEORGE H. WANG, M.D. OB/GYN MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-266-1100
Mailing Address - Street 1:2211 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6833
Mailing Address - Country:US
Mailing Address - Phone:323-266-1100
Mailing Address - Fax:323-266-1199
Practice Address - Street 1:2211 S ATLANTIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6833
Practice Address - Country:US
Practice Address - Phone:323-266-1100
Practice Address - Fax:323-266-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732561Medicaid
A73256Medicare PIN