Provider Demographics
NPI:1700855822
Name:WANG, XINDA D (MD)
Entity Type:Individual
Prefix:
First Name:XINDA
Middle Name:D
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:XINDA
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9620 S 219TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3915 TALBOT RD S STE 300
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5738
Practice Address - Country:US
Practice Address - Phone:425-690-3409
Practice Address - Fax:425-690-9004
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043315207RX0202X
WAWA00043312207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00213596OtherRAILROAD MEDICARE
WA8390676Medicaid
9026WAOtherREGENCE BLUE SHIELD RIDER
WA1016849Medicaid
P00213596OtherRAILROAD MEDICARE