Provider Demographics
NPI:1891713004
Name:WANG, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
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 1:18141 BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1354
Mailing Address - Country:US
Mailing Address - Phone:714-841-7800
Mailing Address - Fax:714-784-7671
Practice Address - Street 1:18141 BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1354
Practice Address - Country:US
Practice Address - Phone:714-841-7800
Practice Address - Fax:714-784-7671
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G628810Medicaid
CAF12077Medicare UPIN
CAG62881Medicare ID - Type Unspecified