Provider Demographics
NPI:1255934717
Name:WANG, YI-HSIANG (DPT)
Entity type:Individual
Prefix:
First Name:YI-HSIANG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1109
Mailing Address - Country:US
Mailing Address - Phone:909-331-9171
Mailing Address - Fax:
Practice Address - Street 1:2 FAIRHAVEN DR
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1109
Practice Address - Country:US
Practice Address - Phone:909-331-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist