Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A80114 | CA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | A80114 | CA |
NPI | 1033286430 |
---|---|
Provider Name | Dr. Casey Lorraine Wang |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 14/06/2012 |