Provider Demographics
NPI:1841215001
Name:WANG, HARRY CARL (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:CARL
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 RIVERSIDE BLVD
Mailing Address - Street 2:SUITE S
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1143
Mailing Address - Country:US
Mailing Address - Phone:916-391-5077
Mailing Address - Fax:916-391-5057
Practice Address - Street 1:6355 RIVERSIDE BLVD
Practice Address - Street 2:SUITE S
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-1143
Practice Address - Country:US
Practice Address - Phone:916-391-5077
Practice Address - Fax:916-391-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG315892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry