Healthcare Provider Details

I. General information

NPI: 1528740354
Provider Name (Legal Business Name): ANNIE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MENG QI WANG

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5404
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 480-301-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number80503
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberV2594
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: