Provider Demographics
NPI:1285747931
Name:WANG, JOHN Z (MD, PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:Z
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ZHENG
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1535 W MERCED AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-338-0811
Mailing Address - Fax:626-338-0922
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-338-0811
Practice Address - Fax:626-338-0922
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A672290Medicaid
CA00A672290Medicaid