Provider Demographics
NPI:1962499616
Name:WANG, GEORGE H (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
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 1:2211 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6833
Mailing Address - Country:US
Mailing Address - Phone:323-266-1100
Mailing Address - Fax:323-266-1199
Practice Address - Street 1:2211 S ATLANTIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6833
Practice Address - Country:US
Practice Address - Phone:323-266-1100
Practice Address - Fax:323-266-1199
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732561Medicaid
CAA73256Medicare ID - Type Unspecified
CA00A732561Medicaid