Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | G80706 | CA |
Y | 2080P0204X | Pediatric Emergency Doctor | R6708 | TX |
NPI | 1083713655 |
---|---|
Provider Name | Vincent Joseph Wang |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75235-7701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G807060 | (05) | CA |