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General NPI Number Information
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NPI Number | 1689626277
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Entity Type | Individual
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Provider Name | EDWARD SHANG JEN WANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 1165 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-4801
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Country | US
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Telephone | 707-525-5207
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Fax | 707-522-1524
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Provider Business Mailing Address
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Address Line | 2 CRYSTAL CREEK DR
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City | LARKSPUR
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State | CA
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Zip | 94939-1491
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Country | US
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Telephone | 415-924-5125
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Fax | 415-924-5126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A045359
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License Number State | CA
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