Provider Demographics
NPI:1548200652
Name:WANG, PING Y (MD)
Entity Type:Individual
Prefix:
First Name:PING
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD
Practice Address - Street 2:STE 310
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-3910
Practice Address - Fax:623-876-6953
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ434027Medicaid
AZ020037148OtherRAILROAD MEDICARE PIN
AZZ65892Medicare PIN
AZG50213Medicare UPIN
AZ434027Medicaid