Provider Demographics
NPI:1982602579
Name:WANG, ROGER HSIO-HSION (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HSIO-HSION
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 1:1125 E 17TH ST
Mailing Address - Street 2:SUITE W239
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2201
Mailing Address - Country:US
Mailing Address - Phone:714-835-1818
Mailing Address - Fax:714-835-7200
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:SUITE W239
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-835-1818
Practice Address - Fax:714-835-7200
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44667207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44667OtherPHYSICIAN LICENSE
CA00A446670Medicaid
CA00A446670Medicaid
CAC23157Medicare UPIN