Provider Demographics
NPI:1013206945
Name:WANG, YEN TUN (MD)
Entity type:Individual
Prefix:
First Name:YEN
Middle Name:TUN
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:YEN TUN
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:888 S FIGUEROA ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5310
Mailing Address - Country:US
Mailing Address - Phone:213-319-3339
Mailing Address - Fax:213-408-4414
Practice Address - Street 1:888 S FIGUEROA ST STE 1050
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5310
Practice Address - Country:US
Practice Address - Phone:213-319-3339
Practice Address - Fax:213-408-4414
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123156207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA123156OtherMEDICAL LICENSE