Provider Demographics
NPI:1972077220
Name:GEORGE WANG,MD,LLC
Entity Type:Organization
Organization Name:GEORGE WANG,MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-967-6888
Mailing Address - Street 1:2919 S ELLSWORTH RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2168
Mailing Address - Country:US
Mailing Address - Phone:480-967-6888
Mailing Address - Fax:480-967-6887
Practice Address - Street 1:4001 E BASELINE RD STE 205
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2743
Practice Address - Country:US
Practice Address - Phone:480-967-6888
Practice Address - Fax:480-967-6887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE WANG MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty