Provider Demographics
NPI:1760490163
Name:WANG, PETER K (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:K
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12555 GARDEN GROVE BLVD
Mailing Address - Street 2:#306
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:714-537-0511
Mailing Address - Fax:714-537-0418
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:#306
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843
Practice Address - Country:US
Practice Address - Phone:714-537-0511
Practice Address - Fax:714-537-0418
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA29582207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A83980Medicare UPIN
A29582Medicare ID - Type Unspecified