Healthcare Provider Details

I. General information

NPI: 1407240096
Provider Name (Legal Business Name): WILLIAM WUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BALFOUR RD STE 201
BRENTWOOD CA
94513-4952
US

IV. Provider business mailing address

1450 TREAT BLVD # 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 925-308-8120
  • Fax: 925-513-2650
Mailing address:
  • Phone: 925-952-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA145714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: