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General NPI Number Information
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NPI Number | 1053492389
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Entity Type | Individual
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Provider Name | PAUL WANG D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 6501 E GREENWAY PKWY STE 103 PMB #158
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2070
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Country | US
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Telephone | 602-494-5015
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Fax | 602-445-9369
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Provider Business Mailing Address
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Address Line | 6501 E GREENWAY PKWY STE 103 PMB #158
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-2070
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Country | US
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Telephone | 602-494-5015
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Fax | 602-445-9369
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4414
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 4414
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 20A10222
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 20A10222
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License Number State | CA
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