MEDICARE: KATHY KAIQIAN WANG

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	208600000X	Surgery Physician	036169958	IL
2	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	036169958	IL

General Provider Information

NPI Number	:	1447712328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY KAIQIAN WANG

Provider Business Mailing Address
First Line	:	180 N JEFFERSON ST UNIT 605
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1472
Country	:	US
Telephone Number	:	940-597-3509
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5147
Country	:	US
Telephone Number	:	773-296-7093
Fax Number	:

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	01/26/2026

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Directions to “ KATHY KAIQIAN WANG ” Practice Location

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