Healthcare Provider Details

I. General information

NPI: 1306575816
Provider Name (Legal Business Name): YAXUAN WANG CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

2300 M ST NW FL W7
WASHINGTON DC
20037-1434
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 202-715-4750
  • Fax: 202-715-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA2000018
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: