Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A83684 | CA |
NPI | 1023114618 |
---|---|
Provider Name | Gloria W Wang |
First Address | San Francisco, CA 94158 |
Second Address | San Francisco, CA 94143-0644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |