Provider Demographics
NPI:1508061201
Name:WANG, DONG-YUN IV
Entity Type:Individual
Prefix:
First Name:DONG-YUN
Middle Name:
Last Name:WANG
Suffix:IV
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 1:4239 GLEANE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2748
Mailing Address - Country:US
Mailing Address - Phone:718-651-9028
Mailing Address - Fax:
Practice Address - Street 1:4265 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3273
Practice Address - Country:US
Practice Address - Phone:718-461-1365
Practice Address - Fax:718-461-5201
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5516540225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant