Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A76003 | CA |
NPI | 1003817776 |
---|---|
Provider Name | Dr. Jennifer P Wang |
First Address | Mountain View, CA 94040 |
Second Address | Mountain View, CA 94040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H45558 | (02) | CA |