Provider Demographics
NPI:1003558487
Name:WANG, YAN (LMT)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 GREEN BAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3118
Mailing Address - Country:US
Mailing Address - Phone:847-266-0131
Mailing Address - Fax:
Practice Address - Street 1:1779 GREEN BAY RD STE 101
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3118
Practice Address - Country:US
Practice Address - Phone:847-266-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.022352225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist