Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E2026 | CA |
N | 222Z00000X | Podiatrist | E2026 | CA |
N | 2081S0010X | Sports Medicine | E2026 | CA |
N | 213ES0000X | Sports Medicine | E2026 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E2026 | CA |
N | 213ES0131X | Foot Surgery | E2026 | CA |
NPI | 1396874061 |
---|---|
Provider Name | Stephen Wan |
First Address | Torrance, CA 90505-4930 |
Second Address | Torrance, CA 90505-4930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 19/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11141 | (02) | CA |
ZZZ28311Z | (05) | CA |