Provider Demographics
NPI:1255431078
Name:JWANG MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:JWANG MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:P
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-969-4600
Mailing Address - Street 1:525 SOUTH DRIVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-969-4600
Mailing Address - Fax:650-969-1936
Practice Address - Street 1:525 SOUTH DRIVE
Practice Address - Street 2:SUITE 219
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-969-4600
Practice Address - Fax:650-969-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5999120001OtherMEDICARE PTAN
CADG2282OtherMEDICARE RAILROAD
CA5999120002OtherMEDICARE PTAN
CA07240150030OtherMEDICARE DMERC
CAP00423519OtherMEDICARE RR PTAN
CA=========OtherMEDICARE DMERC
CA5999120001OtherMEDICARE PTAN
CA=========OtherMEDICARE DMERC
CA5999120002OtherMEDICARE PTAN