Provider Demographics
NPI:1528050606
Name:WANG, FUSHENG (MD)
Entity type:Individual
Prefix:
First Name:FUSHENG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:890 JACKSON ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4867
Mailing Address - Country:US
Mailing Address - Phone:415-982-9688
Mailing Address - Fax:415-982-9689
Practice Address - Street 1:890 JACKSON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4867
Practice Address - Country:US
Practice Address - Phone:415-982-9688
Practice Address - Fax:415-982-9689
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608240Medicaid
CA00A608240Medicaid