Healthcare Provider Details

I. General information

NPI: 1689019010
Provider Name (Legal Business Name): DAVID WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 CAMPUS POINT DR MAILBOX CPC 305
SAN DIEGO CA
92121-1518
US

IV. Provider business mailing address

10010 CAMPUS POINT DRIVE MAILBOX CPC 305
SAN DIEGO CA
92121-1518
US

V. Phone/Fax

Practice location:
  • Phone: 619-452-7071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberA131794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: