Healthcare Provider Details

I. General information

NPI: 1972023166
Provider Name (Legal Business Name): YUMEI MARY WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

IV. Provider business mailing address

38875 MOORE DR
FREMONT CA
94536-4389
US

V. Phone/Fax

Practice location:
  • Phone: 510-252-6815
  • Fax:
Mailing address:
  • Phone: 510-706-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number747128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: