Provider Demographics
NPI:1700889326
Name:WANG, SHOUWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOUWEN
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 1:6622 N 91ST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:3320 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2319
Practice Address - Country:US
Practice Address - Phone:602-200-8288
Practice Address - Fax:602-200-8549
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32615207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847254Medicaid
AZ78844Medicare PIN
AZ134865Medicare PIN
AZZ137201Medicare PIN
NVVWCGWMMedicare PIN
I02386Medicare UPIN
AZ114935Medicare PIN
AZ113566Medicare PIN
AZ847254Medicaid