Healthcare Provider Details

I. General information

NPI: 1033745070
Provider Name (Legal Business Name): MARY WANG MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 JACKSON ST
SAN FRANCISCO CA
94133-4851
US

IV. Provider business mailing address

845 JACKSON ST # B1
SAN FRANCISCO CA
94133-4851
US

V. Phone/Fax

Practice location:
  • Phone: 415-677-2305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1045960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: