Provider Demographics
NPI:1326480450
Name:WANG, JING
Entity Type:Individual
Prefix:MISS
First Name:JING
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S PEORIA ST
Mailing Address - Street 2:APT 605C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3587
Mailing Address - Country:US
Mailing Address - Phone:574-229-6219
Mailing Address - Fax:
Practice Address - Street 1:315 S PEORIA ST
Practice Address - Street 2:APT 605C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3587
Practice Address - Country:US
Practice Address - Phone:574-229-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst