Healthcare Provider Details

I. General information

NPI: 1861360521
Provider Name (Legal Business Name): CORTEX NEUROVASCULAR SOUTH SOUND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 S UNION AVE
TACOMA WA
98405-1328
US

IV. Provider business mailing address

2502 S UNION AVE
TACOMA WA
98405-1328
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-4200
  • Fax:
Mailing address:
  • Phone: 253-761-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS WANG
Title or Position: CEO
Credential: MD
Phone: 206-428-7966