Healthcare Provider Details

I. General information

NPI: 1649105511
Provider Name (Legal Business Name): JORA WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

463 OAK STAND PATH
CHESTERFIELD MO
63005-1299
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-3000
  • Fax:
Mailing address:
  • Phone: 636-544-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026026920
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: