Provider Demographics
NPI:1619991510
Name:WANG, GINA RU-JIUN (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:RU-JIUN
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 9TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6517
Mailing Address - Country:US
Mailing Address - Phone:510-465-3588
Mailing Address - Fax:510-465-4369
Practice Address - Street 1:373 9TH ST STE 403
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6517
Practice Address - Country:US
Practice Address - Phone:510-465-3588
Practice Address - Fax:510-465-4369
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG01484Medicare UPIN