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NPI Code Detail

MEDICARE: PAUL H WANG M DIV PH D & ASSOCIATES P C

MEDICARE: PAUL H WANG M DIV PH D & ASSOCIATES P C
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
1103T00000XPsychologistPSY R0220MO

Other Identifiers

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

General Provider Information

NPI Number : 1952684995
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUL H WANG M DIV PH D & ASSOCIATES P C
Provider Business Mailing Address
First Line : 9666 OLIVE BLVD STE 510
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-3026
Country : US
Telephone Number : 314-721-7777
Fax Number : 314-888-2610
Provider Business Practice Location Address
First Line : 9666 OLIVE BLVD STE 510
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63132-3026
Country : US
Telephone Number : 314-721-7777
Fax Number : 314-888-2610
Authorized Official
Title or Position : PRESIDENT
Name : DR. PAUL H. WANG
Credential : PH.D.
Telephone Number : 314-721-7777
Provider Enumeration Date : 09/26/2011
Last Update Date : 08/21/2024

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