Provider Demographics
NPI:1902847841
Name:OWYANG, DOUGLAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:H
Last Name:OWYANG
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 1:1615 BUNKER HILL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-6013
Mailing Address - Country:US
Mailing Address - Phone:831-796-1304
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:BLDG. 151, SUITE 16
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-769-8640
Practice Address - Fax:831-769-8632
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110102076OtherMEDICARE RR
CA00A260610Medicaid
CA00A260610Medicare ID - Type Unspecified
CA00A260610Medicaid