Provider Demographics
NPI:1740319540
Name:WANG, JIING TSONG (MD)
Entity type:Individual
Prefix:
First Name:JIING
Middle Name:TSONG
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3305
Mailing Address - Country:US
Mailing Address - Phone:626-443-8891
Mailing Address - Fax:626-350-6081
Practice Address - Street 1:11511 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3305
Practice Address - Country:US
Practice Address - Phone:626-443-8891
Practice Address - Fax:626-350-6081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA032418208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice