Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 918837 | CA |
NPI | 1063972131 |
---|---|
Provider Name | Titfany Wang |
First Address | Playa Vista, CA 90094-2494 |
Second Address | Inglewood, CA 90301-4878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2019 |
Last Update Date | 23/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8837362939376 | (05) | CA |