Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | A69484 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD-21142 | HI |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | A69484 | CA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD-21142 | HI |
NPI | 1013931039 |
---|---|
Provider Name | Samuel Wang |
First Address | Honolulu, HI 96819-1469 |
Second Address | Honolulu, HI 96819-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A694840 | (05) | CA |
H45117 | (02) | CA |