Healthcare Provider Details

I. General information

NPI: 1407387731
Provider Name (Legal Business Name): JINGKUN WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KENTUCKY
LEXINGTON KY
40506
US

IV. Provider business mailing address

800 ROSE ST # C-246
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6162
  • Fax:
Mailing address:
  • Phone: 859-323-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56881
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: