Provider Demographics
NPI:1376606194
Name:WANG, JAMES Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:Y
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5421
Mailing Address - Fax:
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5421
Practice Address - Fax:425-317-3975
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23091207R00000X
WAMD60629768207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2057230Medicaid
WA2057230Medicaid