Healthcare Provider Details

I. General information

NPI: 1285365478
Provider Name (Legal Business Name): XINYI WANG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY WANG

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 POST ST
SAN FRANCISCO CA
94115-3427
US

IV. Provider business mailing address

2580 CALIFORNIA ST APT 2304
MOUNTAIN VIEW CA
94040-2772
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7246
  • Fax:
Mailing address:
  • Phone: 917-376-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number35512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35512
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: