Provider Demographics
NPI:1164981817
Name:JANE WANG
Entity Type:Organization
Organization Name:JANE WANG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-671-9884
Mailing Address - Street 1:3663 PARK RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4423
Mailing Address - Country:US
Mailing Address - Phone:916-671-9884
Mailing Address - Fax:855-827-6007
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:209-901-9123
Practice Address - Fax:855-827-6007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANE WANG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty