Healthcare Provider Details

I. General information

NPI: 1750343281
Provider Name (Legal Business Name): WYNN W PAING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 FRANKS RD SUITE# 1
HUNTINGDON VALLEY PA
19006-4215
US

IV. Provider business mailing address

8109 PENNHILL RD
ELKINS PARK PA
19027-2723
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7294
  • Fax: 215-590-7350
Mailing address:
  • Phone: 215-635-9228
  • Fax: 215-635-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD425329
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: