Healthcare Provider Details

I. General information

NPI: 1104765197
Provider Name (Legal Business Name): ZIYI WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY SPC 4300
BERKELEY CA
94720-4304
US

IV. Provider business mailing address

2560 WESTWINDS DR APT 1
IOWA CITY IA
52246-4000
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-9494
  • Fax:
Mailing address:
  • Phone: 319-359-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: