Provider Demographics
NPI:1972558666
Name:WANG, EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1091 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3050
Mailing Address - Country:US
Mailing Address - Phone:707-446-9393
Mailing Address - Fax:707-455-6037
Practice Address - Street 1:175 N JACKSON AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:669-214-2599
Practice Address - Fax:669-214-2766
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54057208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G540570Medicaid
CA00G540570Medicaid
A52646Medicare UPIN