Provider Demographics
NPI:1164610721
Name:WANG MEDICAL GROUP PC
Entity Type:Organization
Organization Name:WANG MEDICAL GROUP PC
Other - Org Name:PARADISE VALLEY PAIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-494-5015
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:SUITE103 PMB 158
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:602-494-5015
Mailing Address - Fax:602-445-9369
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:SUITE 4100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2122
Practice Address - Country:US
Practice Address - Phone:602-494-5015
Practice Address - Fax:602-445-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44142081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1164610721OtherNPI
AZI63995Medicare UPIN
AZ119004Medicare PIN