MEDICARE: JASON WANG

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	363A00000X	Physician Assistant	PA70046447	WA

General Provider Information

NPI Number	:	1174400535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON WANG

Provider Business Mailing Address
First Line	:	PO BOX 5127
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98206-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15418 MAIN ST # 200
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-9030
Country	:	US
Telephone Number	:	425-225-8000
Fax Number	:

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

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	12/08/2025

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Directions to “ JASON WANG ” Practice Location

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