Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD60383479 | WA |
N | 111NI0900X | Internist | MD60383479 | WA |
NPI | 1003130030 |
---|---|
Provider Name | Aaron Tzupeng Fang |
First Address | Seattle, WA 98124-1876 |
Second Address | Renton, WA 98055-5714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 24/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2020314 | (05) | WA |