=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114125580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANN WANG ND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5150 EL CAMINO REAL SUITE B14
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94022-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-327-2053
-----------------------------------------------------
Fax | 650-331-7250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5150 EL CAMINO REAL SUITE B14
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94022-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-327-2053
-----------------------------------------------------
Fax | 650-331-7250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | ND40
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 1506
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------