Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DE60273268 | WA |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD60287538 | WA |
NPI | 1326254038 |
---|---|
Provider Name | Dr. Patrick Wang |
First Address | Kent, WA 98032-4536 |
Second Address | Bonney Lake, WA 98391-8457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 22/12/2016 |