Provider Demographics
NPI:1669673448
Name:ANAN, WENDY WAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:WAN
Last Name:ANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WANWARAT
Other - Middle Name:
Other - Last Name:ANANTHAPANYASUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:24920 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6443
Practice Address - Country:US
Practice Address - Phone:425-690-3544
Practice Address - Fax:425-690-9444
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1616207R00000X, 207RN0300X
WAMD60614954207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60614954OtherWA MEDICAL LICENSE
WA2062995Medicaid
TXP1616OtherLICENSE