Provider Demographics
NPI:1205994159
Name:WANG, YIN-ZU (MD)
Entity type:Individual
Prefix:DR
First Name:YIN-ZU
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7837 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3013
Mailing Address - Country:US
Mailing Address - Phone:626-572-3100
Mailing Address - Fax:626-572-9584
Practice Address - Street 1:7837 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3013
Practice Address - Country:US
Practice Address - Phone:626-572-3100
Practice Address - Fax:626-572-9584
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A381450Medicaid
CAA38145Medicare ID - Type Unspecified
CA00A381450Medicaid