Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | DS037962 | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD455236 | PA |
NPI | 1023244654 |
---|---|
Provider Name | Steven W Wang |
First Address | Philadelphia, PA 19104-4206 |
Second Address | Philadelphia, PA 19104-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 26/09/2019 |