Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DE00010848 | WA |
NPI | 1124047550 |
---|---|
Provider Name | Dr. Derrick I Wang |
First Address | Seattle, WA 98195-7448 |
Second Address | Seattle, WA 98195-7448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 21/11/2016 |