Provider Demographics
NPI:1467844571
Name:WANG, KEVIN CHAO
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHAO
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 W NEWPORT AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2384
Mailing Address - Country:US
Mailing Address - Phone:317-490-5974
Mailing Address - Fax:
Practice Address - Street 1:862 W NEWPORT AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2384
Practice Address - Country:US
Practice Address - Phone:317-490-5974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program