WANG, SAMUEL (MD)

Provider Demographics

• NPI: 1881631935
• Name: WANG, SAMUEL (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: SAMUEL
• Last Name: WANG
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 501 E HAMPDEN AVE
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80113-2702
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2006-05-31
• Last Update Date: 2024-03-31

Provider Licenses

State	License ID	Taxonomies
NE	25105	2085R0202X
KS	04-36535	2085R0202X
HI	MD17525	2085R0202X
CO	39387	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
UT	1881631935	Medicaid
MT	1881631935	Medicaid
SD	1881631935/7729370	Medicaid
OK	200424620A	Medicaid
WY	1881631935	Medicaid
MN	1881631935	Medicaid
NM	80120571	Medicaid
NE	84-059792913	Medicaid
NE	10025709000	Medicaid
MI	104686463	Medicaid
IA	1881631935	Medicaid
MO	200274306	Medicaid
AZ	920505	Medicaid
KS	200417130A	Medicaid
NY	02300223	Medicaid
CO	87879557	Medicaid
TX	204644301	Medicaid
CA	1881631935	Medicaid
WI	99112261	Medicaid
NM	80120571	Medicaid
SD	1881631935/7729370	Medicaid
OK	200424620A	Medicaid
CO	87879557	Medicaid
IA	1881631935	Medicaid
MO	200274306	Medicaid
CO	C444908	Medicare PIN
CO	G62894	Medicare UPIN
MT	1881631935	Medicaid
NE	NA1215047	Medicare PIN
CO	392382ZLJ3	Medicare PIN
KS	200417130A	Medicaid
NY	02300223	Medicaid
KS	KA3249063	Medicare PIN