MEDICARE: OLIVIA J WANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207XS0106X	Orthopaedic Hand Surgery Physician	17143	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CS25988	OTHER	NV	NEVADA STATE BOARD OF PHARMACY
2	17143	OTHER	NV	NEVADA STATE BOARD OF MEDICAL EXAMINERS

General Provider Information

NPI Number	:	1154610137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA J WANG MD

Provider Business Mailing Address
First Line	:	10135 W TWAIN AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6721
Country	:	US
Telephone Number	:	702-458-4263
Fax Number	:

Provider Business Practice Location Address
First Line	:	10135 W TWAIN AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6721
Country	:	US
Telephone Number	:	702-458-4263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	01/23/2023

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Directions to “ OLIVIA J WANG MD” Practice Location

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