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General NPI Number Information
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NPI Number | 1164981817
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Entity Type | Organization
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Legal Business Name | JANE WANG
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 123 S COMMERCE ST STE E
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City | STOCKTON
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State | CA
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Zip | 95202-2837
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Country | US
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Telephone | 209-901-9123
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Fax | 855-827-6007
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Provider Business Mailing Address
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Address Line | 3663 PARK RD
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City | SACRAMENTO
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State | CA
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Zip | 95841-4423
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Country | US
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Telephone | 916-671-9884
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Fax | 855-827-6007
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Authorized Official
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Title or Position | MD/OWNER
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Name | JANE WANG
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Credential |
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Telephone | 916-671-9884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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