Provider Demographics
NPI:1689680548
Name:WANG, JIANGNAN (MD)
Entity Type:Individual
Prefix:
First Name:JIANGNAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13768 ROSWELL AVE 118
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1402
Mailing Address - Country:US
Mailing Address - Phone:909-591-8200
Mailing Address - Fax:909-591-8229
Practice Address - Street 1:13768 ROSWELL AVE STE 118
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1402
Practice Address - Country:US
Practice Address - Phone:909-591-8200
Practice Address - Fax:909-591-8229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73460207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73460AMedicare ID - Type Unspecified
CAH32876Medicare UPIN