Vivian Ty Wan, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

322276 Issued in NY

Practice address

2495 Hospital Dr Ste 670
Mountain View, CA 94040-4187

Phone

(650) 396-8110

NPI assigned

Mar 26, 2019

Last updated

Oct 2, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vwan17542@prd.direct.tbh.org

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.

• Doctor Azad, Medical Corporation

  dba El Camino Women's Medical Group

  • Obstetrics & Gynecology Physician
  • Mountain View, CA
  • NPI 1740410836
  Medicare reassignment NPD
• El Camino Health Medical Network, LLC

  • Multi-Specialty Clinic/Center
  • San Jose, CA
  • NPI 1164880761
  NPD (past)

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1659832251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2495 HOSPITAL DR STE 670",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404187",
            "telephone_number": "650-396-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 HOSPITAL DR STE 670",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404187",
            "telephone_number": "650-396-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAN",
        "first_name": "VIVIAN",
        "middle_name": "TY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-26",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "322276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenzel Wallace
• Walmart Inc. (Walmart Pharmacy 10-2280)
• Walmart, Inc. (Walmart pharmacy 10-3164)
• Caitlin Walsh, PPS SC
• Melissa Rose Walter, LMFT
• Wang Chiropractic
• Benjamin H Wang, DDS
• Catherine Wang
• Cindy Wang, M.D.
• Cynthia Wang

• Obstetrics & Gynecology Physician in Mountain View, CA
• Providers in Mountain View, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.