Provider Demographics
NPI:1013998186
Name:WANG, KENTEN PEY-KUEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KENTEN
Middle Name:PEY-KUEN
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 3850
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-5291
Mailing Address - Fax:916-734-7838
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3850
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-5291
Practice Address - Fax:916-734-7838
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6909208100000X
IL036162106208100000X
CA20A7684208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020AX76840Medicaid
OK201169500AMedicaid