Healthcare Provider Details

I. General information

NPI: 1134516602
Provider Name (Legal Business Name): JOSEPH WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FOREST AVE STE 114
SAN JOSE CA
95128-1472
US

IV. Provider business mailing address

2101 FOREST AVE STE 114
SAN JOSE CA
95128-1472
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-6969
  • Fax:
Mailing address:
  • Phone: 408-918-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA186289
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA186289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: