Individual
STEPHEN WAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3400 LOMITA BLVD STE 403, TORRANCE, CA 90505-4930
(310) 326-8551
Mailing address
3400 LOMITA BLVD STE 403, TORRANCE, CA 90505-4930
(310) 326-8551
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E2026
CA
213ES0000X
Sports Medicine Podiatrist
E2026
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E2026
CA
213ES0131X
Foot Surgery Podiatrist
E2026
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ28311Z
—
CA
Enumeration date
03/05/2007
Last updated
07/19/2010
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