Healthcare Provider Details

I. General information

NPI: 1508472788
Provider Name (Legal Business Name): YUEJUN WANG AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53-59 PUBLIC SQ STE 202
WATERTOWN NY
13601-2674
US

IV. Provider business mailing address

1005 1/2 W SULLIVAN ST
OLEAN NY
14760-2231
US

V. Phone/Fax

Practice location:
  • Phone: 315-786-3225
  • Fax:
Mailing address:
  • Phone: 917-923-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: