Healthcare Provider Details

I. General information

NPI: 1043667751
Provider Name (Legal Business Name): XIAOXIAO WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YUSM-DEPT OF ANESTHESIOLOGY 333 CEDAR ST, TMP 3
NEW HAVEN CT
06510
US

IV. Provider business mailing address

YUSM-DEPT OF ANESTHESIOLOGY 333 CEDAR ST, TMP 3
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68137
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number68137
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: