Provider Demographics
NPI:1033564372
Name:WANG, KAYLLIE (MD)
Entity Type:Individual
Prefix:
First Name:KAYLLIE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WASHINGTON AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3616
Mailing Address - Country:US
Mailing Address - Phone:412-278-3310
Mailing Address - Fax:
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD STE 208
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-3100
Practice Address - Country:US
Practice Address - Phone:412-221-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-23
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD466540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program