Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301106309 | MI |
N | 208600000X | Surgeon | 4301106309 | MI |
N | 208200000X | Surgeon | MT 181967 | PA |
N | 208600000X | Surgeon | MT 181967 | PA |
N | 2086S0129X | Vascular Surgeon | 036125531 | IL |
Y | 2086S0129X | Vascular Surgeon | 40725 | IA |
N | 2086S0129X | Vascular Surgeon | 4301106309 | MI |
NPI | 1164612453 |
---|---|
Provider Name | Dr. Wade Wei Kang |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036125531 | (05) | IL |
040113 | (05) | IA |
10026291800 | (05) | NE |
201007480B | (05) | IN |