Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS030776L | PA |
N | 122300000X | Dentist | OMS49 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401411829 | VA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0438000234 | VA |
N | 204E00000X | Oral & Maxillofacial Surgeon | OMS49 | CA |
NPI | 1053489088 |
---|---|
Provider Name | Richard Ke Ming Wang |
First Address | Alexandria, VA 22304-3418 |
Second Address | Alexandria, VA 22304-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 05/10/2007 |