Provider Demographics
NPI:1245473230
Name:WANG, ZHIYU (MD)
Entity type:Individual
Prefix:
First Name:ZHIYU
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 1:1628 S MILDRED ST
Mailing Address - Street 2:STE 104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1627
Mailing Address - Country:US
Mailing Address - Phone:253-565-6777
Mailing Address - Fax:253-565-8777
Practice Address - Street 1:1628 S MILDRED ST
Practice Address - Street 2:STE 104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1627
Practice Address - Country:US
Practice Address - Phone:253-565-6777
Practice Address - Fax:253-565-8777
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60209366207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0282781OtherL&I
WAG8902127OtherMEDICARE
WA0282545OtherL&I