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General NPI Number Information
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NPI Number | 1861648487
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Entity Type | Individual
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Provider Name | LI WANG MD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 22707 SE 29TH ST
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City | SAMMAMISH
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State | WA
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Zip | 98075-9532
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Country | US
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Telephone | 425-455-2845
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Fax | 425-861-8602
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Provider Business Mailing Address
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Address Line | PO BOX 25608
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0608
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Country | US
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Telephone | 206-320-4476
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Fax | 206-568-7043
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301093329
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60226723
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License Number State | WA
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