Provider Demographics
NPI:1760481048
Name:WANG, ZHIQIAN (MD)
Entity Type:Individual
Prefix:
First Name:ZHIQIAN
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 1:11311 BRIDGEPORT WAY SW
Mailing Address - Street 2:STE 214
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-985-6490
Mailing Address - Fax:253-985-6488
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:STE 214
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-985-6490
Practice Address - Fax:253-985-6488
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047633207RR0500X, 207R00000X
ND9748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13111Medicaid
WA0253085OtherSTATE L&I
WA0253087OtherSTATE L&I
WA0253085OtherSTATE L&I
ND24637Medicare ID - Type Unspecified
WA0253087OtherSTATE L&I
I11737Medicare UPIN