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NPI Code Detail

MEDICARE: DR. JESSICA WANG DO

MEDICARE: DR. JESSICA WANG DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianOT018118PA
22084P0800XPsychiatry Physician20A18814CA

General Provider Information

NPI Number : 1528588555
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA WANG DO
Provider Business Mailing Address
First Line : 675 W FOOTHILL BLVD STE 200
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-3475
Country : US
Telephone Number : 925-282-1778
Fax Number : 415-296-5299
Provider Business Practice Location Address
First Line : 675 W FOOTHILL BLVD STE 200
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-3475
Country : US
Telephone Number : 925-282-1778
Fax Number : 415-296-5299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2017
Last Update Date : 08/23/2024

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