Provider Demographics
NPI:1245249374
Name:WANG, SAN YOU (MD)
Entity type:Individual
Prefix:
First Name:SAN
Middle Name:YOU
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 1:1200 CENTRE STREET
Mailing Address - Street 2:DEPT OF MEDICINE HEBREW REHABILITATION CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-363-8303
Mailing Address - Fax:
Practice Address - Street 1:1200 CENTRE STREET
Practice Address - Street 2:HEBREW REHABILITATION CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-363-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47836207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A14165Medicare UPIN