Healthcare Provider Details

I. General information

NPI: 1295362689
Provider Name (Legal Business Name): STEVEN WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 N DIXON RD
KOKOMO IN
46901-4154
US

IV. Provider business mailing address

138 N DIXON RD
KOKOMO IN
46901-4154
US

V. Phone/Fax

Practice location:
  • Phone: 765-236-8320
  • Fax: 765-200-7637
Mailing address:
  • Phone: 765-236-8320
  • Fax: 765-200-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01096255A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: