Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | BW2798809 | WA |
Y | 207RP1001X | Pulmonary Disease | MD00031893 | WA |
NPI | 1033260815 |
---|---|
Provider Name | Bennet M. Wang |
First Address | Bellevue, WA 98004-8578 |
Second Address | Bellevue, WA 98004-8578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8211849 | (05) | WA |
G55848 | (02) | WA |