Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4275 | CA |
Y | 222Z00000X | Podiatrist | E4275 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E4275 | CA |
NPI | 1063516409 |
---|---|
Provider Name | Dr. Oliver Wang |
First Address | Pasadena, CA 91106-5314 |
Second Address | Burbank, CA 91502-1825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 06/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90300 | (02) | CA |