1255431078 NPI number — JWANG MEDICAL GROUP, INC.

Table of content: (NPI 1255431078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255431078 NPI number — JWANG MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JWANG MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255431078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 SOUTH DRIVE
Provider Second Line Business Mailing Address:
SUITE 219
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-969-4600
Provider Business Mailing Address Fax Number:
650-969-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 SOUTH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 219
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-969-4600
Provider Business Practice Location Address Fax Number:
650-969-1936
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
650-969-4600

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A76003 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5999120001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DG2282 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5999120002 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 07240150030 . This is a "MEDICARE DMERC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00423519 . This is a "MEDICARE RR PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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