Healthcare Provider Details

I. General information

NPI: 1962546473
Provider Name (Legal Business Name): CHING-ENG H WANG PHD, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

5806 CAPULINA AVE
MORTON GROVE IL
60053-3001
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-1695
  • Fax:
Mailing address:
  • Phone: 847-966-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: