Healthcare Provider Details

I. General information

NPI: 1689519738
Provider Name (Legal Business Name): JASMIN WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1080
US

IV. Provider business mailing address

67116 BURNS ST
FOREST HILLS NY
11375-4146
US

V. Phone/Fax

Practice location:
  • Phone: 808-369-1234
  • Fax: 808-369-1212
Mailing address:
  • Phone: 718-570-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMDR-9217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: