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General NPI Number Information
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NPI Number | 1114714219
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Entity Type | Organization
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Legal Business Name | JIA YU WANG
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1225 CRANE ST STE 109
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City | MENLO PARK
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State | CA
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Zip | 94025-4253
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Country | US
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Telephone | 650-223-5821
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Fax | 650-487-8883
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Provider Business Mailing Address
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Address Line | 2625 MIDDLEFIELD RD # 179
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City | PALO ALTO
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State | CA
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Zip | 94306-2516
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Country | US
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Telephone | 650-223-5821
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Fax | 650-487-8883
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Authorized Official
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Title or Position | PRIMARY CARE PROVIDER
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Name | DR. JIA YU WANG
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Credential | MD
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Telephone | 773-969-0151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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