Provider Demographics
NPI:1477626679
Name:WANG, ANNIE TAK AN HUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:TAK AN HUNG
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNIE
Other - Middle Name:TAK AN
Other - Last Name:HUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:213 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1217
Mailing Address - Country:US
Mailing Address - Phone:610-664-5333
Mailing Address - Fax:
Practice Address - Street 1:3001 WALNUT STREET
Practice Address - Street 2:JFK SOUTHWEST MEDICAL CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3414
Practice Address - Country:US
Practice Address - Phone:215-386-3556
Practice Address - Fax:215-386-8074
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009160E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C27591Medicare UPIN