Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 30.024914 | OH |
Y | 1223P0300X | Periodontist | S173 | MN |
NPI | 1124484969 |
---|---|
Provider Name | Yun Wang |
First Address | Minneapolis, MN 55455 |
Second Address | Minneapolis, MN 55455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2016 |
Last Update Date | 05/01/2022 |