Provider Demographics
NPI:1326029513
Name:WANG, GRACE JEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:JEN
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-615-4949
Mailing Address - Fax:215-243-4649
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-615-4949
Practice Address - Fax:215-243-4649
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431585208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery