Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 274824 | MA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 28862 | MN |
NPI | 1255836979 |
---|---|
Provider Name | Dr. Kemble Kangyu Wang |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 29/04/2019 |