Provider Demographics
NPI:1225006935
Name:WANG, JAMES JINGBO (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JINGBO
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 1:450 AVON BELDEN RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2282
Mailing Address - Country:US
Mailing Address - Phone:440-930-6800
Mailing Address - Fax:
Practice Address - Street 1:450 AVON BELDEN RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2282
Practice Address - Country:US
Practice Address - Phone:440-930-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3507662600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110216284OtherRR MEDICARE INDIVIDUAL
0119204OtherGROUP MEDICAID
CA4511OtherRR MEDICARE GROUP
9273172OtherGROUP MEDICARE
D368301OtherGROUP IND DIAGNOSTICS MED
1780634279OtherGROUP NPI
3610861OtherGROUP ASC MEDICARE
10814863OtherCAQH
103464OtherKAISER
OH2144932Medicaid
9273172OtherGROUP MEDICARE