Healthcare Provider Details

I. General information

NPI: 1154884591
Provider Name (Legal Business Name): CHARLIE YI WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

2401 EUCLID HEIGHTS BLVD APT 5
CLEVELAND OH
44106-2724
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1537
  • Fax: 415-476-0616
Mailing address:
  • Phone: 513-907-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA182413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: