# MICHAEL WAN, M.D., INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MICHAEL WAN, M.D.,INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962755702
- **Legal business name:** MICHAEL WAN, M.D.,INC.
- **Authorized official:** DR. MICHAEL WAN M.D. (PRESIDENT)
- **Authorized official phone:** (714) 546-6600

## Contact information

- **Practice address:** 11100 WARNER AVE, SUITE 150B, FOUNTAIN VALLEY, CA 92708-7506
- **Practice address phone:** (714) 546-6600
- **Practice address fax:** (714) 546-6608
- **Mailing address:** 11100 WARNER AVE, SUITE 150B, FOUNTAIN VALLEY, CA 92708-7506
- **Mailing address phone:** (714) 546-6600
- **Mailing address fax:** (714) 546-6608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A36431 | CA | Yes |

## Other

- **Enumeration date:** 10/17/2012
- **Last updated:** 10/17/2012