Healthcare Provider Details

I. General information

NPI: 1639630874
Provider Name (Legal Business Name): GERALD WANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR RM H3680
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR RM H3680
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-5948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number20A22368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: