Healthcare Provider Details

I. General information

NPI: 1568856417
Provider Name (Legal Business Name): QINYUN WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/09/2019
Certification Date: WANG QINYUN 8801 HORIZON BLVD NE STE 360 ALBUQUERQUE NM 87113 8801 HORIZON BLVD NE STE 360 ALBUQUERQUE NM 87113
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

IV. Provider business mailing address

8801 HORIZON BLVD NE STE 360
ALBUQUERQUE NM
87113-1563
US

V. Phone/Fax

Practice location:
  • Phone: 58-284-9235
  • Fax: 505-213-0103
Mailing address:
  • Phone: 58-284-9235
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology
License NumberA147423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: