Healthcare Provider Details

I. General information

NPI: 1205324829
Provider Name (Legal Business Name): MIN LI WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

438 N WHITE RD
SAN JOSE CA
95127-1439
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax:
Mailing address:
  • Phone: 408-254-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95141623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: