Provider Demographics
NPI:1255781654
Name:WANG, ZIYI (MD)
Entity type:Individual
Prefix:
First Name:ZIYI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
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:PO BOX 402381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2381
Mailing Address - Country:US
Mailing Address - Phone:801-294-9333
Mailing Address - Fax:801-294-7558
Practice Address - Street 1:444 W BOURNE CIR STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3656
Practice Address - Country:US
Practice Address - Phone:801-294-9333
Practice Address - Fax:801-294-7558
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1518293323Medicaid