Provider Demographics
NPI:1598831026
Name:WANG, SHIRLEY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:Y
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:14517 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2694
Mailing Address - Country:US
Mailing Address - Phone:316-300-5401
Mailing Address - Fax:
Practice Address - Street 1:8101 COLLEGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2671
Practice Address - Country:US
Practice Address - Phone:913-210-5400
Practice Address - Fax:913-393-4282
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431075207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200626990AMedicaid
KS200626990AMedicaid