Individual provider Active NPI

Shuo Wang

  • Pediatric Cardiology Physician
  • Los Angeles, CA
National Provider Identifier
1760826697
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
A133605 Issued in CA
Practice address
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone
(323) 361-2749
NPI assigned
Apr 22, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A133605 CA
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Cardiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0202X A133605 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Mailing address

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-2749

Other practice location 1

757 Westwood Plz
B711 Rrumc
Los Angeles, CA 90095-7419
Phone (310) 267-9129

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210209001884 CA Practitioner - Cardiovascular Disease (Cardiology) 5799190542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Un of California, Irvine, College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Hospital Los Angeles Medical Group IncGroup PAC ID 0143126920, 288 clinicians

Practice addresses (Care Compare)

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-8408

Hospital & facility affiliations

  • Children'S Hosp of Los Angeles Hospital, Los Angeles, CA, CCN 053302

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A133605CAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Los Angeles Medical Group, Inc. Single Specialty CurrentSince Sep 1, 2020 Accepting new patients
Childrens Hospital Medical Practice Corporation Single Specialty Past Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients

Locations

3701 Wilshire Blvd
Ste 600
Los Angeles, CA 90010
Phone (323) 361-3550

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1760826697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2749",
            "fax_number": "323-361-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "757 Westwood Plz",
            "address_2": "B711 RRUMC",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900957419",
            "country_code": "US",
            "telephone_number": "310-267-9129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "SHUO",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-22",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A133605",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A133605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.