Provider Demographics
NPI:1194073577
Name:WANG, TOM YEN-PO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:YEN-PO
Last Name:WANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 VIA MARISOL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4801
Mailing Address - Country:US
Mailing Address - Phone:626-675-7778
Mailing Address - Fax:
Practice Address - Street 1:6865 ALTON PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3739
Practice Address - Country:US
Practice Address - Phone:949-612-6088
Practice Address - Fax:949-612-6082
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 60159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist