Provider Demographics
NPI:1447266317
Name:WANG, LINA (MD)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-2582
Mailing Address - Fax:323-442-2588
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-2582
Practice Address - Fax:323-442-2588
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64308207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00290174OtherMEDICARE RAILROAD
CA1952325565OtherGROUP NPI
CA00A643080OtherBLUE SHIELD
CA00A643080Medicaid
CA00A643080Medicaid
CAWA64308AMedicare PIN
CAHW7801BMedicare PIN
CAH43906Medicare UPIN
CAHW7801AMedicare PIN
CA1952325565OtherGROUP NPI