MEDICARE: EILEEN WANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	340673	NY
2	207L00000X	Anesthesiology Physician	A172748	CA
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	A172748	CA

General Provider Information

NPI Number	:	1033642871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN WANG MD

Provider Business Mailing Address
First Line	:	275 HOSPITAL PKWY STE 470
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1138
Country	:	US
Telephone Number	:	408-972-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 SPRING BROOK AVE
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3709
Country	:	US
Telephone Number	:	845-876-3001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2017
Last Update Date	:	03/05/2026

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