MEDICARE: KEVIN WANG M.D. INC.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1720571607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN WANG M.D. INC.

Provider Business Mailing Address
First Line	:	1201 2ND AVE STE 1400
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-3020
Country	:	US
Telephone Number	:	206-395-7870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 NORTHPOINT PKWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-7398
Country	:	US
Telephone Number	:	707-526-3180
Fax Number	:	707-755-8968

Authorized Official
Title or Position	:	LICENSING ANALYST
Name	:	MELISSA HIRSCHFELDER
Credential	:
Telephone Number	:	206-395-7870

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	01/09/2024

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