Provider Demographics
NPI:1730129271
Name:WANG, CHUNG NAN (MD)
Entity Type:Individual
Prefix:
First Name:CHUNG
Middle Name:NAN
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 1:6073 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1131
Mailing Address - Country:US
Mailing Address - Phone:805-644-6600
Mailing Address - Fax:
Practice Address - Street 1:3525 LOMA VISTA RD
Practice Address - Street 2:SUITE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3101
Practice Address - Country:US
Practice Address - Phone:805-641-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31187207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology