Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G79462 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G79462 | CA |
N | 207ND0900X | Dermatopathologist | G79462 | CA |
N | 207NP0225X | Pediatric Dermatologist | G79462 | CA |
N | 207NS0135X | Procedural Dermatology | G79462 | CA |
NPI | 1013091396 |
---|---|
Provider Name | James T Wang |
First Address | Rancho Santa Margarita, CA 92688-3619 |
Second Address | Rancho Santa Margarita, CA 92688-3619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G16947 | (02) | CA |