Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A62529 | CA |
NPI | 1033116223 |
---|---|
Provider Name | William Gang Wang |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 03/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A460840 | (05) | CA |
E38986 | (02) | CA |