1376694919 NPI number — MISS YUNCHUAN WANG NP

Table of content: MISS YUNCHUAN WANG NP (NPI 1376694919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376694919 NPI number — MISS YUNCHUAN WANG NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
YUNCHUAN
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WANG
Provider Other First Name:
JANE
Provider Other Middle Name:
YUNCHUAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376694919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 AMHERST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94025-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-260-2246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 WELCH RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-725-6667
Provider Business Practice Location Address Fax Number:
650-725-6685
Provider Enumeration Date:
01/12/2007

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: 363LF0000X , with the licence number:  F13416 , 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)