Healthcare Provider Details

I. General information

NPI: 1336189000
Provider Name (Legal Business Name): YUE-LYNN WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3675
  • Fax: 215-728-2848
Mailing address:
  • Phone: 215-728-3675
  • Fax: 215-728-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number225055
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberMD467247
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: