Healthcare Provider Details

I. General information

NPI: 1275514937
Provider Name (Legal Business Name): JASON WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MADISON ST 355
DENVER CO
80206-5419
US

IV. Provider business mailing address

55 MADISON ST 355
DENVER CO
80206-5419
US

V. Phone/Fax

Practice location:
  • Phone: 303-398-7320
  • Fax: 303-388-0606
Mailing address:
  • Phone: 303-377-2020
  • Fax: 303-377-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0040750
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDR.0040750
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: