Healthcare Provider Details

I. General information

NPI: 1922215540
Provider Name (Legal Business Name): ALLEN YU-LUN WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 POCOSHOCK PL
RICHMOND VA
23235-6345
US

IV. Provider business mailing address

9356 WARM WATERS AVE
LAS VEGAS NV
89129-7865
US

V. Phone/Fax

Practice location:
  • Phone: 804-276-9305
  • Fax: 804-674-4145
Mailing address:
  • Phone: 857-891-1839
  • Fax: 804-562-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116018162
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: