1194790691 NPI number — DR. KUO-YING JOCELYN WANG

Table of content: DR. KUO-YING JOCELYN WANG (NPI 1194790691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194790691 NPI number — DR. KUO-YING JOCELYN WANG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
KUO-YING
Provider Middle Name:
JOCELYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194790691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-853-4749
Provider Business Mailing Address Fax Number:
513-852-8525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10495 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-4468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-984-2775
Provider Business Practice Location Address Fax Number:
513-984-5764
Provider Enumeration Date:
02/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  35067518 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200314690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2022484 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110221144 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".