Provider Demographics
NPI:1154384352
Name:WANG, JOHN C (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-3067
Mailing Address - Country:US
Mailing Address - Phone:530-751-4784
Mailing Address - Fax:530-751-4906
Practice Address - Street 1:370 DEL NORTE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4142
Practice Address - Country:US
Practice Address - Phone:530-674-8031
Practice Address - Fax:530-751-4158
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3866208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340020371OtherMEDICARE RAILROAD
TX8G4510OtherBLUECROSS/BLUESHIELD
TX10006843OtherAMERIGROUP
TX1527616-01Medicaid
TX7430373OtherAETNA
TX340020371OtherMEDICARE RAILROAD
TXH67332Medicare UPIN