Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | G81232 | CA |
NPI | 1073794368 |
---|---|
Provider Name | Linda Wang |
First Address | Long Beach, CA 90806-1516 |
Second Address | Long Beach, CA 90806-1516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2007 |
Last Update Date | 09/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G812320 | (05) | CA |
H21036 | (02) | CA |