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General NPI Number Information
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NPI Number | 1750678017
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Entity Type | Individual
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Provider Name | HONGTAO ALEX WANG M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1191 E HERNDON AVE STE 103
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City | FRESNO
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State | CA
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Zip | 93720-3164
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Country | US
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Telephone | 559-794-2168
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Fax | 559-272-1387
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Provider Business Mailing Address
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Address Line | 1191 E HERNDON AVE STE 103
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City | FRESNO
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State | CA
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Zip | 93720-3164
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Country | US
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Telephone | 559-794-2168
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Fax | 559-272-1387
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.172476
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A168782
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 036.172476
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | R5678
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | A168782
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License Number State | CA
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