Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A113291 | CA |
N | 2080P0208X | Pediatric Infectious Diseases | 254739 | MA |
NPI | 1306072970 |
---|---|
Provider Name | Dr. Marie E-Jen Wang |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 24/06/2016 |