Healthcare Provider Details

I. General information

NPI: 1174977300
Provider Name (Legal Business Name): YI WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE STREET
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-7119
  • Fax: 215-662-7200
Mailing address:
  • Phone: 215-662-7119
  • Fax: 215-662-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD645139
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: