MEDICARE: JUNG WANG CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SP 17657	CA

General Provider Information

NPI Number	:	1356778757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNG WANG CCC-SLP

Provider Business Mailing Address
First Line	:	809 CUESTA DR # 106B
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-3667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 OYSTER POINT BLVD STE 202
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1928
Country	:	US
Telephone Number	:	650-758-4700
Fax Number	:

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

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	09/30/2013

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Directions to “ JUNG WANG CCC-SLP” Practice Location

Language	Start Address	Practice Location

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