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General NPI Number Information
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NPI Number | 1962614388
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Entity Type | Individual
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Provider Name | JIM WANG DO
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Gender | Male
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2210 E CALVADA BLVD
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City | PAHRUMP
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State | NV
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Zip | 89048-5804
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Country | US
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Telephone | 775-727-6400
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Fax | 775-727-7543
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-877-5199
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 907
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License Number State | NV
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