Healthcare Provider Details

I. General information

NPI: 1003251687
Provider Name (Legal Business Name): SANG MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 S ST
FRESNO CA
93721-1430
US

IV. Provider business mailing address

1122 S ST SUITE 102
FRESNO CA
93721-1430
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-1737
  • Fax: 559-268-1738
Mailing address:
  • Phone: 559-268-1737
  • Fax: 559-268-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93522
License Number StateCA

VIII. Authorized Official

Name: DR. NEW SANG
Title or Position: OWNER
Credential: M.D.
Phone: 559-268-1737