Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125.072150 | IL |
N | 111NI0900X | Internist | 125.072150 | IL |
Y | 207RG0100X | Gastroenterologist | TL.0009003 | CO |
NPI | 1043703507 |
---|---|
Provider Name | Jing Zhou Wang |
First Address | Burr Ridge, IL 60527-6686 |
Second Address | Aurora, CO 80045-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2018 |
Last Update Date | 16/08/2021 |