Healthcare Provider Details

I. General information

NPI: 1932794823
Provider Name (Legal Business Name): PETER WHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1000
  • Fax:
Mailing address:
  • Phone: 916-781-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: