Provider Demographics
NPI:1689626277
Name:WANG, EDWARD SHANG JEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SHANG JEN
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 CRYSTAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1491
Mailing Address - Country:US
Mailing Address - Phone:415-924-5125
Mailing Address - Fax:415-924-5126
Practice Address - Street 1:1165 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4801
Practice Address - Country:US
Practice Address - Phone:707-525-5207
Practice Address - Fax:707-522-1524
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA045359207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine