Provider Demographics
NPI:1669564811
Name:WANG, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1118 S GARFIELD AVE
Mailing Address - Street 2:201
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4713
Mailing Address - Country:US
Mailing Address - Phone:626-281-0090
Mailing Address - Fax:626-281-0261
Practice Address - Street 1:18395 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2749
Practice Address - Country:US
Practice Address - Phone:626-964-1120
Practice Address - Fax:626-964-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA61785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine