Provider Demographics
NPI:1003817776
Name:WANG, JENNIFER P (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:P
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:525 SOUTH DRIVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-969-4600
Mailing Address - Fax:650-969-1936
Practice Address - Street 1:525 SOUTH DRIVE
Practice Address - Street 2:SUITE 219
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-969-4600
Practice Address - Fax:650-969-1936
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA76003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH45558Medicare UPIN
CA00A760030Medicare PIN