1902920408 NPI number — WANG WELLNESS CLINIC, P.S., INC.

Table of content: (NPI 1902920408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902920408 NPI number — WANG WELLNESS CLINIC, P.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WANG WELLNESS CLINIC, P.S., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902920408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 116TH AVE NE STE 116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-5233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-688-1994
Provider Business Mailing Address Fax Number:
425-688-1990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4629 168TH STREET SW
Provider Second Line Business Practice Location Address:
STB
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-688-1994
Provider Business Practice Location Address Fax Number:
425-688-1990
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-688-1994

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3517 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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