Provider Demographics
NPI:1164522165
Name:WANG, ROGER RONGQING (DO)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:RONGQING
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MERCED AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1027
Mailing Address - Country:US
Mailing Address - Phone:415-242-4611
Mailing Address - Fax:
Practice Address - Street 1:950 STOCKTON ST
Practice Address - Street 2:SUITE 399
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1633
Practice Address - Country:US
Practice Address - Phone:415-677-0901
Practice Address - Fax:415-677-0885
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10816207R00000X, 207RR0500X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00355266OtherMEDICAID
CU971AMedicare UPIN
CA00355266OtherMEDICAID