Provider Demographics
NPI:1043488661
Name:WANG, HUIJIAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:HUIJIAN
Middle Name:JAMES
Last Name:WANG
Suffix:
Gender:M
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:PO BOX 291427
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-1427
Mailing Address - Country:US
Mailing Address - Phone:386-672-1023
Mailing Address - Fax:386-263-2996
Practice Address - Street 1:1240 W GRANADA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5915
Practice Address - Country:US
Practice Address - Phone:386-672-1023
Practice Address - Fax:386-263-2996
Is Sole Proprietor?:No
Enumeration Date:2008-02-16
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089536207RC0000X, 207RC0001X
FLME101341207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM138ZMedicare PIN