Healthcare Provider Details

I. General information

NPI: 1649803321
Provider Name (Legal Business Name): SIMENG WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 09/27/2023
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 164TH AVE. NE SUITE A215
REDMOND WA
98052
US

IV. Provider business mailing address

2475 140TH AVE. NE BUILDING C
BELLEVUE WA
98005
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-9292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61292824
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN60611149
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: