Healthcare Provider Details

I. General information

NPI: 1346165867
Provider Name (Legal Business Name): JOHNSTON Y WANG CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2170
  • Fax: 813-518-7659
Mailing address:
  • Phone: 916-453-2170
  • Fax: 813-518-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO04913
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO04913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: