Provider Demographics
NPI:1619920923
Name:WANG, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
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 1:701 E. MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-431-5262
Mailing Address - Fax:302-366-1240
Practice Address - Street 1:701 E. MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-431-5262
Practice Address - Fax:302-366-1240
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006344207RP1001X
PAMD430301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079589000OtherAMERIHEALTH/KEYSTONE
230008OtherMAMSI
DE0001190201Medicaid
2846278OtherAETNA/USHC
58685590OtherTRICARE
MD61500301OtherCAREFIRST BCBS
2486924001OtherCIGNA
1390191OtherINDEPENDENCE BCBS
176717OtherCOVENTRY
1390191OtherINDEPENDENCE BCBS
176717OtherCOVENTRY
H54037Medicare UPIN