Healthcare Provider Details

I. General information

NPI: 1255632550
Provider Name (Legal Business Name): BAY AREA SLEEP MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 SAMARITAN DRIVE SUITE 10
SAN JOSE CA
95124-4005
US

IV. Provider business mailing address

2504 SAMARITAN DRIVE SUITE 10
SAN JOSE CA
95124-4005
US

V. Phone/Fax

Practice location:
  • Phone: 408-216-8763
  • Fax: 408-416-3706
Mailing address:
  • Phone: 408-216-8763
  • Fax: 408-416-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA91418
License Number StateCA

VIII. Authorized Official

Name: WEI WANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-216-8763