Provider Demographics
NPI:1881743193
Name:WANG, DOROTHY ZHIJUAN (OD)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ZHIJUAN
Last Name:WANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ZHIJUAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13350 CAMINO DEL SUR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4473
Mailing Address - Country:US
Mailing Address - Phone:858-324-0089
Mailing Address - Fax:858-324-0090
Practice Address - Street 1:13350 CAMINO DEL SUR
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4473
Practice Address - Country:US
Practice Address - Phone:858-324-0089
Practice Address - Fax:858-324-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4573152W00000X
CA13420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP13420AOtherMEDICARE PROVIDER NUMBER