Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A89339 | CA |
NPI | 1003013715 |
---|---|
Provider Name | Dr. Roberta Yiwun Wang |
First Address | Vallejo, CA 94589 |
Second Address | Vallejo, CA 94589-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 08/07/2007 |