Provider Demographics
NPI:1114125580
Name:WANG, SUZANN (ND)
Entity Type:Individual
Prefix:DR
First Name:SUZANN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 EL CAMINO REAL
Mailing Address - Street 2:SUITE B14
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1534
Mailing Address - Country:US
Mailing Address - Phone:650-327-2053
Mailing Address - Fax:650-331-7250
Practice Address - Street 1:5150 EL CAMINO REAL
Practice Address - Street 2:SUITE B14
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1534
Practice Address - Country:US
Practice Address - Phone:650-327-2053
Practice Address - Fax:650-331-7250
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND40175F00000X
OR1506175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath