MEDICARE: DAVID L WANG DO

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	207Q00000X	Family Medicine Physician	OP61371215	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	:	1700312444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L WANG DO

Provider Business Mailing Address
First Line	:	450 S KITSAP BLVD STE 210
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3738
Country	:	US
Telephone Number	:	360-895-8900
Fax Number	:	360-895-8999

Provider Business Practice Location Address
First Line	:	450 S KITSAP BLVD STE 210
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3738
Country	:	US
Telephone Number	:	360-895-8900
Fax Number	:	360-895-8999

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

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	03/02/2026

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