Healthcare Provider Details

I. General information

NPI: 1134540859
Provider Name (Legal Business Name): SIAO-YI WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 45TH ST
SACRAMENTO CA
95817-1514
US

IV. Provider business mailing address

4501 X ST STE 3016
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5959
  • Fax: 916-703-5265
Mailing address:
  • Phone: 916-734-5959
  • Fax: 916-703-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number186824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: