Provider Demographics
NPI:1700059151
Name:WANG, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
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 1:1263 E ARQUES AVE
Mailing Address - Street 2:ARQUES MEDICAL OFFICES
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4701
Mailing Address - Country:US
Mailing Address - Phone:408-530-2900
Mailing Address - Fax:408-530-2901
Practice Address - Street 1:1263 E ARQUES AVE
Practice Address - Street 2:ARQUES MEDICAL OFFICES
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4701
Practice Address - Country:US
Practice Address - Phone:408-530-2900
Practice Address - Fax:408-530-2901
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1028722081P2900X, 208100000X, 208VP0014X
NY237555390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program