Provider Demographics
NPI:1245792647
Name:WANG ANESTHESIA NURSING MANAGEMENT INC
Entity type:Organization
Organization Name:WANG ANESTHESIA NURSING MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:310-795-5988
Mailing Address - Street 1:3019 OCEAN PARK BLVD UNIT 358
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3004
Mailing Address - Country:US
Mailing Address - Phone:310-795-5988
Mailing Address - Fax:
Practice Address - Street 1:4738 LA VILLA MARINA UNIT K
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7030
Practice Address - Country:US
Practice Address - Phone:310-795-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty