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General NPI Number Information
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NPI Number | 1902367766
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Entity Type | Individual
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Provider Name | KEVIN WANG DO
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Gender | Male
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 1005 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-2834
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Country | US
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Telephone | 217-223-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-2834
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Country | US
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Telephone | 217-223-1200
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2019021744
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2022004128
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101027375
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2019021744
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036175383
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License Number State | IL
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