Provider Demographics
NPI:1164612453
Name:KANG, WADE WEI (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:WEI
Last Name:KANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-283A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-7696
Mailing Address - Fax:269-488-8313
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-283A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-7696
Practice Address - Fax:269-488-8313
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT 181967208600000X
MI4301106309208600000X, 2086S0129X
IL0361255312086S0129X
IA407252086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201007480BMedicaid
IL036125531Medicaid
NE10026291800Medicaid
IA040113Medicaid
IL036125531Medicaid
ILP00867342Medicare PIN