Healthcare Provider Details

I. General information

NPI: 1366928616
Provider Name (Legal Business Name): DAVID TING-CHANG WANG MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219
US

IV. Provider business mailing address

234 GOODMAN STREET PO BOX 670761
CINCINNATI OH
45267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-4396
  • Fax:
Mailing address:
  • Phone: 513-584-0431
  • Fax: 513-584-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number57.245150
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35139189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: