Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 58486 | MN |
Y | 207N00000X | Dermatologist | A156280 | CA |
N | 207R00000X | Internist | 57.022590 | OH |
N | 111NI0900X | Internist | 57.022590 | OH |
NPI | 1053744912 |
---|---|
Provider Name | Michael Zhaoyu Wang |
First Address | San Francisco, CA 94115-3011 |
Second Address | Rochester, MN 55905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 10/06/2019 |