MEDICARE: DR. CHANG-YANG WANG M.D.

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	207Y00000X	Otolaryngology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21606779	OTHER	IL	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1831161959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANG-YANG WANG M.D.

Provider Business Mailing Address
First Line	:	4901 W 79TH ST
Second Line	:	6
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-425-1320
Fax Number	:	708-425-1312

Provider Business Practice Location Address
First Line	:	4901 W 79TH ST
Second Line	:	6
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-425-1320
Fax Number	:	708-425-1312

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CHANG-YANG WANG M.D.” Practice Location

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