Provider Demographics
NPI:1669638441
Name:WANG, VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27882 FORBES RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1267
Mailing Address - Country:US
Mailing Address - Phone:949-364-9264
Mailing Address - Fax:949-364-9264
Practice Address - Street 1:27882 FORBES RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1267
Practice Address - Country:US
Practice Address - Phone:949-364-9264
Practice Address - Fax:949-364-9264
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036123058207N00000X
CAA110942207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3080Medicare UPIN