Provider Demographics
NPI:1053485557
Name:WANG, ZHIQIANG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ZHIQIANG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 GROUSE RUN DR APT 124
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5373
Mailing Address - Country:US
Mailing Address - Phone:650-492-0118
Mailing Address - Fax:650-903-9900
Practice Address - Street 1:123 S COMMERCE ST STE E
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2837
Practice Address - Country:US
Practice Address - Phone:650-492-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65222207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042170Medicaid
CAH21659Medicare UPIN
CA00A652220Medicare ID - Type UnspecifiedMEDICARE NO.