Provider Demographics
NPI:1649204397
Name:WANG, VICTOR SHERWIN (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:SHERWIN
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FL
Mailing Address - Street 2:393 E WALNUT ST
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:1050 E YORBA LINDA BLVD
Practice Address - Street 2:#103 THE INTERNAL MEDICINE GROUP
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3730
Practice Address - Country:US
Practice Address - Phone:714-996-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227891207R00000X
CAA86616207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL515OtherMEDICARE PTAN