Healthcare Provider Details

I. General information

NPI: 1265312995
Provider Name (Legal Business Name): VALLEY GASTROENTEROLOGY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 16TH ST STE 103
BAKERSFIELD CA
93301-3453
US

IV. Provider business mailing address

1191 E HERNDON AVE STE 103
FRESNO CA
93720-3164
US

V. Phone/Fax

Practice location:
  • Phone: 916-292-8938
  • Fax: 916-938-2123
Mailing address:
  • Phone: 916-292-8938
  • Fax: 916-938-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: HONGTAO ALEX WANG
Title or Position: CEO
Credential: MD
Phone: 916-292-8938