Provider Demographics
NPI:1114064490
Name:DONG, LIN-WANG (MD)
Entity Type:Individual
Prefix:
First Name:LIN-WANG
Middle Name:
Last Name:DONG
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 1:1800 15TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-392-0900
Mailing Address - Fax:970-506-3796
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-392-0900
Practice Address - Fax:970-506-3796
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44502207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO300892Medicare PIN