Basic Information
| Provider Information | |||||||||
| NPI: | 1396106936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WANG INTEGRATIVE REHABILITATION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12664 CHAPMAN AVE | ||||||||
| Address2: | UNIT 1414 | ||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928404000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162398682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 E BONITA AVE | ||||||||
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| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094500158 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2016 | ||||||||
| LastUpdateDate: | 04/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | WANG | ||||||||
| AuthorizedOfficialFirstName: | KENTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9162398682 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 20A7684 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.