Basic Information
| Provider Information | |||||||||
| NPI: | 1174023113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | QING | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040 JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682462 | ||||||||
| FaxNumber: | 2539682972 | ||||||||
| Practice Location | |||||||||
| Address1: | 9040 JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682462 | ||||||||
| FaxNumber: | 2539682972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2018 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 32091 | NE | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.