Healthcare Provider Details

I. General information

NPI: 1285046920
Provider Name (Legal Business Name): HAI WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

PO BOX 37504
BALTIMORE MD
21297-3504
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3600
  • Fax:
Mailing address:
  • Phone: 571-472-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number0101281911
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: