Provider Demographics
NPI:1689671893
Name:WANG, XIN (MD)
Entity Type:Individual
Prefix:
First Name:XIN
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 1:2102 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1753
Mailing Address - Country:US
Mailing Address - Phone:253-581-2514
Mailing Address - Fax:
Practice Address - Street 1:2102 S 96TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1753
Practice Address - Country:US
Practice Address - Phone:253-581-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA196056OtherLABOR & IND
WA8905408OtherCRIME VICTIMS
OR269767Medicaid
WA8422479Medicaid
P00244937OtherRR MEDICARE
WA8905408OtherCRIME VICTIMS
OR269767Medicaid