Provider Demographics
NPI:1598830176
Name:WANG, FEN (MD)
Entity Type:Individual
Prefix:DR
First Name:FEN
Middle Name:
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:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-3644
Mailing Address - Fax:913-588-3663
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 4033
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-3644
Practice Address - Fax:913-588-3663
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-297882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
31416011OtherBCBS KANSAS CITY
KS100421420AMedicaid
KS100421420DMedicaid
MO205924301Medicaid
920007208Medicare ID - Type UnspecifiedRAIL ROAD
KS068002442Medicare PIN
KS100421420DMedicaid
KSH64672Medicare UPIN