Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A130943 | CA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A130943 | CA |
NPI | 1730317603 |
---|---|
Provider Name | Dr. William Wang |
First Address | Mission Viejo, CA 92691-8001 |
Second Address | Mission Viejo, CA 92691-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 17/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB242792 | (02) |