NPIMap

Individual provider Active NPI

Kaidong Wang, M.D.

  • Physical Medicine & Rehabilitation Physician
  • San Jose, CA
National Provider Identifier
1164576708
Registry record updated May 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
C54585 Issued in CA
Practice address
2664 Senter Rd
214
San Jose, CA 95111-1171
Phone
(520) 861-4363
NPI assigned
Jan 22, 2007
Last updated
May 2, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X C54585 CA Primary

Addresses

Primary practice location

2664 Senter Rd
214
San Jose, CA 95111-1171

Mailing address

2664 Senter Rd
214
San Jose, CA 95111-1171
Phone (520) 861-4363

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110801000809 CA Practitioner - Physical Medicine and Rehabilitation 1052379971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598-3122
Phone (925) 939-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kaidong Wang M.D. Physical Medicine & Rehabilitation CurrentSince Jun 30, 2011 Accepting new patients
John Muir Health Past Accepting new patients
City of Tucson Past Accepting new patients

Locations

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

Interoperability endpoints

  • Direct secure messaging: kwang239872@hisp.ehr.sutterhealth.org
  • Direct secure messaging: kwang425682@direct.peacehealth.org

Organizations & group practices 3

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 10

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": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462147200000",
    "number": "1164576708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2664 SENTER RD",
            "address_2": "214",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951111171",
            "telephone_number": "520-861-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2664 SENTER RD",
            "address_2": "214",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951111171",
            "telephone_number": "520-861-4363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "KAIDONG",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2016-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "C54585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.