Healthcare Provider Details

I. General information

NPI: 1518323633
Provider Name (Legal Business Name): XUEYANG WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH WANG

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S SHARON AMITY RD STE 100
CHARLOTTE NC
28211-3870
US

IV. Provider business mailing address

PO BOX 60160
CHARLOTTE NC
28260-0160
US

V. Phone/Fax

Practice location:
  • Phone: 704-365-0555
  • Fax: 704-367-8122
Mailing address:
  • Phone: 704-365-0555
  • Fax: 704-367-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD93664
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number2023-00887
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2023-00887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: