Provider Demographics
NPI:1922447218
Name:WANG, BURTON TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:BURTON
Middle Name:TIMOTHY
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 1:264 N. HIGHLAND SPRINGS
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-769-0079
Mailing Address - Fax:888-854-7592
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE STE 4&5A
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-769-0079
Practice Address - Fax:888-854-7592
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine