1780766931 NPI number — YU WANG MD

Table of content: YU WANG MD (NPI 1780766931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780766931 NPI number — YU WANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
YU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1780766931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16150 NE 85TH ST
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-698-7436
Provider Business Mailing Address Fax Number:
425-526-7288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16150 NE 85TH ST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-698-7436
Provider Business Practice Location Address Fax Number:
425-526-7288
Provider Enumeration Date:
10/19/2006

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: 207P00000X , with the licence number:  5070 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 5070 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD00048868 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 36919 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00455204 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 36919 . This is a "IA MEDICAL LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 8498495 . This is a "MEDICAL ASST ID (MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD00048868 . This is a "WA MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5070 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".