MEDICARE: HERBERT L 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	2085R0001X	Radiation Oncology Physician	MD00043822	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699746081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT L WANG MD

Provider Business Mailing Address
First Line	:	4230 BRIDGEPORT WAY W STE B
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4335
Country	:	US
Telephone Number	:	253-779-6325
Fax Number	:	253-627-8792

Provider Business Practice Location Address
First Line	:	1802 YAKIMA AVE STE 103
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-5303
Country	:	US
Telephone Number	:	253-272-1077
Fax Number	:	253-627-8792

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	09/10/2020

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