Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20A10816 | CA |
N | 111NI0900X | Internist | 20A10816 | CA |
Y | 207RA0201X | Internist - Allergy & Immunology | 20A10816 | CA |
N | 207RR0500X | Rheumatology | 20A10816 | CA |
NPI | 1164522165 |
---|---|
Provider Name | Roger Rongqing Wang |
First Address | San Francisco, CA 94127-1027 |
Second Address | San Francisco, CA 94108-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 09/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00355266 | MEDICAID (01) | CA |
CU971A | (02) |