Individual
KETTY C WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1667 DOMINICAN WAY STE 230, SANTA CRUZ, CA 95065-1560
(831) 458-6288
(831) 477-9026
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95027289
CA
363LC0200X
Critical Care Medicine Nurse Practitioner
95027289
CA
Other
Enumeration date
11/02/2023
Last updated
07/22/2026
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