Provider Demographics
NPI:1457679805
Name:WANG, XIAOQIN JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:XIAOQIN
Middle Name:JENNIFER
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:HX302
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-5069
Mailing Address - Fax:859-257-5128
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:HX302
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-5069
Practice Address - Fax:859-257-5128
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR23992085R0202X
IL3360988282085R0202X
KY483552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY207RA0401XOtherADDICTION MEDICINE
KY48355OtherMEDICAL LICENSE