Provider Demographics
NPI:1629853072
Name:WANG, RUOGU JASON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUOGU
Middle Name:JASON
Last Name:WANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7916
Mailing Address - Country:US
Mailing Address - Phone:202-830-7358
Mailing Address - Fax:
Practice Address - Street 1:3815 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7916
Practice Address - Country:US
Practice Address - Phone:202-830-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program