MEDICARE: ALLAN WANG MD LLC

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	207K00000X	Allergy & Immunology Physician	9287	HI

General Provider Information

NPI Number	:	1700055217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLAN WANG MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 31000
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96849-5516
Country	:	US
Telephone Number	:	808-329-9264
Fax Number	:

Provider Business Practice Location Address
First Line	:	75-166 KALANI ST
Second Line	:	SUITE 204
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-1857
Country	:	US
Telephone Number	:	808-329-9264
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PHYSICIAN
Name	:	DR. ALLAN VEH TUC WANG
Credential	:	MD, PHD
Telephone Number	:	808-989-6543

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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