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General NPI Number Information
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NPI Number | 1154944585
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Entity Type | Individual
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Provider Name | JONATHAN WAN DO
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Gender | Male
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 786-624-2825
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Fax | 305-669-6531
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Provider Business Mailing Address
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Address Line | 3100 SW 62ND AVE
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City | MIAMI
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State | FL
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Zip | 33155-3009
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Country | US
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Telephone | 786-624-2825
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Fax | 305-669-6531
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS19875
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License Number State | FL
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