MEDICARE: DR. ANNIE TAK AN HUNG 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	208000000X	Pediatrics Physician	MD009160E	PA

General Provider Information

NPI Number	:	1477626679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE TAK AN HUNG WANG MD

Provider Business Mailing Address
First Line	:	213 WINDING WAY
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1217
Country	:	US
Telephone Number	:	610-664-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 WALNUT STREET
Second Line	:	JFK SOUTHWEST MEDICAL CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3414
Country	:	US
Telephone Number	:	215-386-3556
Fax Number	:	215-386-8074

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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