Individual provider Active NPI

Mary Wang, MD

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1053567842
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A102257 Issued in CA
Practice address
9333 Genesee Ave Ste 200
San Diego, CA 92121-2113
Phone
(858) 657-8600
NPI assigned
Aug 12, 2008
Last updated
Feb 16, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A102257 CA Primary

Addresses

Primary practice location

9333 Genesee Ave Ste 200
San Diego, CA 92121-2113

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other practice location 1

6000 N Figueroa St
Los Angeles, CA 90042-4232
Phone (999) 999-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090106000682 CA Practitioner - Family Practice 3779646450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

4168 Front St
San Diego, CA 92103-2030
Phone (858) 657-7000

9333 Genesee Ave
San Diego, CA 92121-2111
Phone (800) 926-8273

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jun 6, 2011 Accepting new patients
Regents of the University of California Family Medicine CurrentSince Jun 6, 2011 Accepting new patients
West Suburban Hospital Medical Center Past Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

9333 Genesee Ave
Ste 200
San Diego, CA 92121
Phone (858) 657-8600

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1053567842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9333 GENESEE AVE STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212113",
            "telephone_number": "858-657-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6000 N Figueroa St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900424232",
            "country_code": "US",
            "telephone_number": "999-999-9999",
            "fax_number": "999-999-9999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-12",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A102257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.