Healthcare Provider Details

I. General information

NPI: 1316478191
Provider Name (Legal Business Name): CHRISTOPHER KUAN WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

IV. Provider business mailing address

350 N ERVAY ST APT 1706
DALLAS TX
75201-3911
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMED-PHYS-COM-LIC-132
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61153830
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberT9277
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number297260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: