Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036.095866 | IL |
NPI | 1003402751 |
---|---|
Provider Name | Ailee Wang |
First Address | Barrington, IL 60010-4025 |
Second Address | Elgin, IL 60123-4988 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2020 |
Last Update Date | 16/12/2020 |