Provider Demographics
NPI:1538232137
Name:WANG, SHUO STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHUO
Middle Name:STEVEN
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-0010
Mailing Address - Country:US
Mailing Address - Phone:626-679-5118
Mailing Address - Fax:213-830-8998
Practice Address - Street 1:711 W COLLEGE ST
Practice Address - Street 2:SUITE#210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1163
Practice Address - Country:US
Practice Address - Phone:626-679-5118
Practice Address - Fax:213-830-8998
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A761440Medicaid
CA00A761440Medicaid
CAI68159Medicare UPIN