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General NPI Number Information
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NPI Number | 1326103862
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Entity Type | Organization
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Legal Business Name | JEFFREY J WANG MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1644 S COURT ST
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City | VISALIA
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State | CA
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Zip | 93277-4962
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Country | US
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Telephone | 559-739-0739
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Fax | 559-739-0825
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Provider Business Mailing Address
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Address Line | 1644 S COURT ST
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City | VISALIA
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State | CA
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Zip | 93277-4962
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Country | US
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Telephone | 559-739-0739
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Fax | 559-739-0825
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY J WANG
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Credential | M.D.
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Telephone | 559-739-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A54108
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License Number State | CA
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