MEDICARE: JIANYUN WANG LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	MA60069632	WA

General Provider Information

NPI Number	:	1265670707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIANYUN WANG LMP

Provider Business Mailing Address
First Line	:	10212 5TH AVE NE STE 140
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-7471
Country	:	US
Telephone Number	:	206-440-1634
Fax Number	:

Provider Business Practice Location Address
First Line	:	10212 5TH AVE NE STE 140
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-7471
Country	:	US
Telephone Number	:	206-440-1634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/21/2009

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Directions to “ JIANYUN WANG LMP” Practice Location

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