Healthcare Provider Details

I. General information

NPI: 1558467787
Provider Name (Legal Business Name): ANDREW MING-YU WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 KENYON ST SUITE 201
SAN DIEGO CA
92110-5341
US

IV. Provider business mailing address

5651 COPLEY DR
SAN DIEGO CA
92111-7903
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2704
  • Fax: 619-727-4266
Mailing address:
  • Phone: 858-499-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA43341
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA43341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: