Healthcare Provider Details

I. General information

NPI: 1861416232
Provider Name (Legal Business Name): PAUL WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 ENGLE RD SUITE# 3
CARMICHAEL CA
95608-2223
US

IV. Provider business mailing address

4705 ENGLE RD SUITE# 3
CARMICHAEL CA
95608-2223
US

V. Phone/Fax

Practice location:
  • Phone: 916-972-1010
  • Fax: 916-972-8508
Mailing address:
  • Phone: 916-972-1010
  • Fax: 916-972-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA89787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: