Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A98344 | CA |
N | 208600000X | Surgeon | A98344 | CA |
N | 208200000X | Surgeon | Q1765 | TX |
N | 208600000X | Surgeon | Q1765 | TX |
Y | 2086X0206X | Surgical Oncologist | Q1765 | TX |
NPI | 1154440501 |
---|---|
Provider Name | Sam Chung-Kang Wang |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 16/09/2014 |