Healthcare Provider Details

I. General information

NPI: 1710412085
Provider Name (Legal Business Name): LIN WANG M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 10/02/2024
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SACRAMENTO ST
SAN FRANCISCO CA
94115
US

IV. Provider business mailing address

2324 SACRAMENTO ST
SAN FRANCISCO CA
94115
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-0160
  • Fax: 415-558-7036
Mailing address:
  • Phone: 415-668-0160
  • Fax: 415-558-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA159290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: