Provider Demographics
NPI:1710207212
Name:WANG, MELISSA LAI-JENN (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAI-JENN
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LOMITA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5038
Mailing Address - Country:US
Mailing Address - Phone:310-257-0028
Mailing Address - Fax:310-257-0031
Practice Address - Street 1:3500 LOMITA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5038
Practice Address - Country:US
Practice Address - Phone:310-257-0028
Practice Address - Fax:310-257-0031
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022445390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program