Provider Demographics
NPI:1114714219
Name:JIA YU WANG
Entity type:Organization
Organization Name:JIA YU WANG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIA
Authorized Official - Middle Name:YU
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-969-0151
Mailing Address - Street 1:2625 MIDDLEFIELD RD # 179
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2516
Mailing Address - Country:US
Mailing Address - Phone:650-223-5821
Mailing Address - Fax:650-487-8883
Practice Address - Street 1:1225 CRANE ST STE 109
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4253
Practice Address - Country:US
Practice Address - Phone:650-223-5821
Practice Address - Fax:650-487-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty