Provider Demographics
NPI:1891929931
Name:WANG, JIAN-FENG
Entity Type:Individual
Prefix:
First Name:JIAN-FENG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 MCCHARLES DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1074
Mailing Address - Country:US
Mailing Address - Phone:781-863-0113
Mailing Address - Fax:
Practice Address - Street 1:31 COLUMBIA
Practice Address - Street 2:CLARIENT PATHOLOGY SERVICE
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1460
Practice Address - Country:US
Practice Address - Phone:949-425-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229771207ZP0102X
CAA117332207ZP0102X
NY265294-1207ZP0102X
FLME113849207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology