=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669777074
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN WING-LUN WAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2011
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 N MEACHAM RD
-----------------------------------------------------
City | SCHAUMBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60173-4824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-364-7850
-----------------------------------------------------
Fax | 630-432-6604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POB 7132960
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-469-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 036133552
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 036133552
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------