Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G76303 | CA |
NPI | 1134257058 |
---|---|
Provider Name | Jeffrey C Wang |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 07/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G51447 | (02) | CA |