Provider Demographics
NPI:1316797699
Name:WANG, CAMILLE SIQI
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:SIQI
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2517
Mailing Address - Country:US
Mailing Address - Phone:626-592-5852
Mailing Address - Fax:
Practice Address - Street 1:1851 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2517
Practice Address - Country:US
Practice Address - Phone:626-592-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program