Healthcare Provider Details

I. General information

NPI: 1386960847
Provider Name (Legal Business Name): KRYSTLE G WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HOSPITAL DR
MOUNTAIN VIEW CA
94040-4122
US

IV. Provider business mailing address

2490 HOSPITAL DR STE 201
MOUNTAIN VIEW CA
94040-4124
US

V. Phone/Fax

Practice location:
  • Phone: 650-962-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 117991
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA141215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: