=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831358134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANNY C WANG MD, MPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2008
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2833 WYNSUM AVE
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-5408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-650-5999
-----------------------------------------------------
Fax | 717-812-2244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2833 WYNSUM AVE
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-5408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-650-5999
-----------------------------------------------------
Fax | 717-812-2244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 260040
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 260040
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | MD445965
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------