Healthcare Provider Details

I. General information

NPI: 1114187325
Provider Name (Legal Business Name): KEVIN WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5597 N DIXIE HWY
OAKLAND PARK FL
33334-3406
US

IV. Provider business mailing address

5597 N DIXIE HWY
OAKLAND PARK FL
33334-3406
US

V. Phone/Fax

Practice location:
  • Phone: 818-917-1293
  • Fax:
Mailing address:
  • Phone: 818-917-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME118773
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number237456
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: