Healthcare Provider Details

I. General information

NPI: 1982539094
Provider Name (Legal Business Name): MELANIE WANG PA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43658 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9819
US

IV. Provider business mailing address

43658 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9819
US

V. Phone/Fax

Practice location:
  • Phone: 530-999-9020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: