MEDICARE: GRACE WANG MD

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	207Q00000X	Family Medicine Physician	MD00034417	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619086386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE WANG MD

Provider Business Mailing Address
First Line	:	PO BOX 3007
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98114-3007
Country	:	US
Telephone Number	:	206-788-3616
Fax Number	:	206-652-5216

Provider Business Practice Location Address
First Line	:	3815 S OTHELLO ST
Second Line	:	2ND FL.
City	:	SEATTLE
State	:	WA
Zip	:	98118-3510
Country	:	US
Telephone Number	:	206-788-3535
Fax Number	:	206-788-3521

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/03/2020

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