Provider Demographics
NPI:1346336195
Name:WANG, DANIEL Y
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SUNNYSLOPE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5784
Mailing Address - Country:US
Mailing Address - Phone:626-203-6827
Mailing Address - Fax:
Practice Address - Street 1:920 SUNNYSLOPE RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5784
Practice Address - Country:US
Practice Address - Phone:626-203-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A967920Medicaid
CABB146ZMedicare PIN
CA00A967920Medicaid