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NPI Code Detail

MEDICARE: JIM WANG

MEDICARE: JIM WANG
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
1183500000XPharmacistRPH61743CA

General Provider Information

NPI Number : 1558646794
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIM WANG
Provider Business Mailing Address
First Line : 3531 DICKENSON CMN
Second Line :
City : FREMONT
State : CA
Zip : 94538-2271
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15500 WASHINGTON AVE
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94579-1839
Country : US
Telephone Number : 510-483-3917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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