Healthcare Provider Details

I. General information

NPI: 1124384425
Provider Name (Legal Business Name): RICHARD JIN-YUAN WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE 5K-1
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

505 PARNASSUS AVE MOFFITT ROOM M1097 BOX 0111
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8314
  • Fax:
Mailing address:
  • Phone: 415-476-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: