Provider Demographics
NPI:1912177627
Name:WANG, JIAKUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIAKUN
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 1:11504 NE 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3025
Mailing Address - Country:US
Mailing Address - Phone:425-698-3033
Mailing Address - Fax:425-968-6357
Practice Address - Street 1:11504 NE 21ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3025
Practice Address - Country:US
Practice Address - Phone:425-698-3033
Practice Address - Fax:425-968-6357
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60003277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine