Healthcare Provider Details

I. General information

NPI: 1700813318
Provider Name (Legal Business Name): SHENG-YONG WANG M.D. & PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 MONTPELIER DR SUITE 8
SAN JOSE CA
95116-1612
US

IV. Provider business mailing address

2324 MONTPELIER DR SUITE 8
SAN JOSE CA
95116-1612
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-8818
  • Fax: 408-272-8828
Mailing address:
  • Phone: 408-272-8818
  • Fax: 408-272-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL3517
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA74153
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberL3517
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: