Provider Demographics
NPI:1275821720
Name:WANG, YAWEN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:YAWEN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
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 1:1705 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1902
Mailing Address - Country:US
Mailing Address - Phone:661-322-3008
Mailing Address - Fax:661-322-5507
Practice Address - Street 1:1705 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1902
Practice Address - Country:US
Practice Address - Phone:661-322-3008
Practice Address - Fax:661-322-5507
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN567672084N0400X
NC2016-008192084N0400X
CAA1503442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275821720Medicaid
NC19JC6OtherBCBS OF NC
NCNCS724AMedicare PIN
MNH400100681Medicare PIN