Provider Demographics
NPI:1093873036
Name:WANG, HAO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HAO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 120TH AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3003
Mailing Address - Country:US
Mailing Address - Phone:425-821-6363
Mailing Address - Fax:425-821-4804
Practice Address - Street 1:12815 120TH AVE NE STE C
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3003
Practice Address - Country:US
Practice Address - Phone:425-821-6363
Practice Address - Fax:425-821-4804
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040931207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH71194Medicare UPIN
WAAB33037Medicare ID - Type Unspecified