Healthcare Provider Details

I. General information

NPI: 1710636816
Provider Name (Legal Business Name): SIQIU WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLLEGE ST
RICHMOND VA
23298-5017
US

IV. Provider business mailing address

1825 E MARSHALL ST APT 144
RICHMOND VA
23223-7382
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7232
  • Fax:
Mailing address:
  • Phone: 512-954-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: