Healthcare Provider Details

I. General information

NPI: 1942472352
Provider Name (Legal Business Name): YANLIN WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4888
  • Fax: 860-679-1153
Mailing address:
  • Phone: 860-679-4888
  • Fax: 860-679-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM4638
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number061176
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: