Healthcare Provider Details

I. General information

NPI: 1437785862
Provider Name (Legal Business Name): BRIAN JAMES WANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 07/23/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

13001 E 17TH PL FL 2
AURORA CO
80045-2570
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 720-848-3000
  • Fax: 720-848-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0006148
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: