MEDICARE: DR. GING-LONG WANG M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	A24551	CA
2	2084P0800X	Psychiatry Physician	A24551	CA

General Provider Information

NPI Number	:	1104166321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GING-LONG WANG M.D.

Provider Business Mailing Address
First Line	:	1720 EL CAMINO REAL STE 140
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 EL CAMINO REAL STE 140
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3231
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:

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

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	08/29/2024

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