Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.133944 | OH |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD61140500 | WA |
NPI | 1104212398 |
---|---|
Provider Name | Timothy Wang |
First Address | Alpharetta, GA 30022-3767 |
Second Address | Seattle, WA 98122-4379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2015 |
Last Update Date | 19/04/2021 |