Provider Demographics
NPI:1205173895
Name:WANG, KENNETH (MD , DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD , DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#88 SONG GAO ROAD 11F-2
Mailing Address - Street 2:
Mailing Address - City:TAIPEI
Mailing Address - State:TAIWAN
Mailing Address - Zip Code:110
Mailing Address - Country:TW
Mailing Address - Phone:88693-792-6710
Mailing Address - Fax:
Practice Address - Street 1:88 SONG GAO ROAD 11F-2
Practice Address - Street 2:
Practice Address - City:TAIPEI
Practice Address - State:TAIWAN
Practice Address - Zip Code:110
Practice Address - Country:TW
Practice Address - Phone:88693-792-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A8688OtherPHYSICIAN LICENSE NUMBER