Healthcare Provider Details

I. General information

NPI: 1578603338
Provider Name (Legal Business Name): WENDY WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

IV. Provider business mailing address

1957 BOXELDER TRL
RIDGEWAY SC
29130-9267
US

V. Phone/Fax

Practice location:
  • Phone: 803-318-5340
  • Fax:
Mailing address:
  • Phone: 803-318-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD35578
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number235726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: