Provider Demographics
NPI:1013091396
Name:WANG, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29833 SANTA MARGARITA PKWY
Mailing Address - Street 2:100
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3619
Mailing Address - Country:US
Mailing Address - Phone:949-888-9288
Mailing Address - Fax:949-888-8918
Practice Address - Street 1:29833 SANTA MARGARITA PKWY
Practice Address - Street 2:100
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3619
Practice Address - Country:US
Practice Address - Phone:949-888-9288
Practice Address - Fax:949-888-8918
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79462207ND0101X, 207ND0900X, 207NP0225X, 207NS0135X, 207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16947Medicare UPIN