Provider Demographics
NPI:1033188602
Name:WANG, PAMELA (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:#130
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4034
Mailing Address - Country:US
Mailing Address - Phone:925-820-6456
Mailing Address - Fax:925-820-1134
Practice Address - Street 1:901 SAN RAMON VALLEY BLVD
Practice Address - Street 2:#130
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4034
Practice Address - Country:US
Practice Address - Phone:925-820-6456
Practice Address - Fax:925-820-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF94968Medicare UPIN
CA00G770720Medicare PIN