Provider Demographics
NPI:1013925726
Name:HENRY WANG INC
Entity Type:Organization
Organization Name:HENRY WANG INC
Other - Org Name:WANG MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-889-8355
Mailing Address - Street 1:1346 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8510
Mailing Address - Country:US
Mailing Address - Phone:702-889-8355
Mailing Address - Fax:702-889-8699
Practice Address - Street 1:1346 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8510
Practice Address - Country:US
Practice Address - Phone:702-889-8355
Practice Address - Fax:702-889-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019876Medicaid
NVV36475Medicare PIN
NV002019876Medicaid