Provider Demographics
NPI:1104818590
Name:WANG, QINGPING (MD, PHD)
Entity type:Individual
Prefix:
First Name:QINGPING
Middle Name:
Last Name:WANG
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 GELLERT BLVD 1103
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5431
Mailing Address - Country:US
Mailing Address - Phone:650-502-3388
Mailing Address - Fax:
Practice Address - Street 1:2260 GELLERT BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5419
Practice Address - Country:US
Practice Address - Phone:650-502-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC146170207RG0300X
MI4301104029207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31287Medicare UPIN
PA456458OtherHIGHMARK BLUE SHIELD
PA0482595000OtherPENNSYLVANIA IBC
PA01836988Medicaid
PA01836988Medicaid