Provider Demographics
NPI:1154417061
Name:WANG, PEAN-YUAN (MD)
Entity type:Individual
Prefix:
First Name:PEAN-YUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 SOUTH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-7053
Mailing Address - Country:US
Mailing Address - Phone:562-402-2993
Mailing Address - Fax:562-860-1819
Practice Address - Street 1:12225 SOUTH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7053
Practice Address - Country:US
Practice Address - Phone:562-402-2993
Practice Address - Fax:562-860-1819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37759207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377591Medicaid
CA00A377591Medicaid
B50359Medicare UPIN