Provider Demographics
NPI:1962496182
Name:WANG, BENJAMIN JENG-SHING (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JENG-SHING
Last Name:WANG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RIVER OAKS
Mailing Address - Street 2:STE 813
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409
Mailing Address - Country:US
Mailing Address - Phone:708-862-5783
Mailing Address - Fax:708-862-5784
Practice Address - Street 1:80 RIVER OAKS
Practice Address - Street 2:STE 813
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409
Practice Address - Country:US
Practice Address - Phone:708-862-5783
Practice Address - Fax:708-862-5784
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4029169OtherAETNA
IL036061248Medicaid
IL0031600025OtherBLUE CROSS BLUE SHIELD
IL687490Medicare ID - Type Unspecified
D14901Medicare UPIN