1700059151 NPI number — DR. KEVIN WANG MD

Table of content: DR. KEVIN WANG MD (NPI 1700059151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700059151 NPI number — DR. KEVIN WANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
KEVIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1700059151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1263 E ARQUES AVE
Provider Second Line Business Mailing Address:
ARQUES MEDICAL OFFICES
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94085-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-530-2900
Provider Business Mailing Address Fax Number:
408-530-2901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1263 E ARQUES AVE
Provider Second Line Business Practice Location Address:
ARQUES MEDICAL OFFICES
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94085-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-530-2900
Provider Business Practice Location Address Fax Number:
408-530-2901
Provider Enumeration Date:
04/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A102872 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: A102872 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: A102872 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 237555 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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