Provider Demographics
NPI:1831393842
Name:WANG, PAGE INMAN
Entity type:Individual
Prefix:
First Name:PAGE
Middle Name:INMAN
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 45TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4705 45TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3921
Practice Address - Country:US
Practice Address - Phone:734-478-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605425452085R0202X
AZ493042085R0202X
FL1204562085R0202X
IL0361356102085R0202X
IN010742692085R0202X
KY475762085R0202X
MI43010903102085R0202X
MO20140188072085R0202X
OH35.1242502085R0202X
PA4521022085R0202X
TN516322085R0202X
WV259902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology