Provider Demographics
NPI:1578764593
Name:WANG, JIMMY CHIHHONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:CHIHHONG
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 1:2020 PALOMINO LN
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4842
Mailing Address - Country:US
Mailing Address - Phone:702-759-8600
Mailing Address - Fax:702-384-1815
Practice Address - Street 1:2020 PALOMINO LN
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4842
Practice Address - Country:US
Practice Address - Phone:702-759-8600
Practice Address - Fax:702-384-1815
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1108832085R0202X
NV146092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01285910OtherRR DRS
NVP001148261OtherRR MEDICARE
NV1578764593Medicaid
CA1578764593Medicaid
NV1578764593Medicaid
CAP01285910OtherRR DRS
NVP001148261OtherRR MEDICARE
CA1578764593Medicaid
CADK156XMedicare PIN
CAP01285910OtherRR DRS