Provider Demographics
NPI:1912905787
Name:WANG, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:210 N GARFIELD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1746
Mailing Address - Country:US
Mailing Address - Phone:626-307-9009
Mailing Address - Fax:626-307-1807
Practice Address - Street 1:210 N GARFIELD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1746
Practice Address - Country:US
Practice Address - Phone:626-307-9009
Practice Address - Fax:626-307-1807
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC37520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C375201Medicaid
CA00C375200Medicaid
CA00C375200Medicaid