Healthcare Provider Details

I. General information

NPI: 1811082860
Provider Name (Legal Business Name): BOBBY HUNG-JEH WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 ADA PL NE
ALBUQUERQUE NM
87106-2502
US

IV. Provider business mailing address

2312 ADA PL NE
ALBUQUERQUE NM
87106-2502
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-1493
  • Fax: 505-256-1492
Mailing address:
  • Phone: 505-256-1493
  • Fax: 505-256-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number85-119
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: