Basic Information
| Provider Information | |||||||||
| NPI: | 1053347906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | YUNG-SHUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 NW 14TH TERRACE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436946 | ||||||||
| FaxNumber: | 3052433337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1095 NW 14TH TERRACE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436946 | ||||||||
| FaxNumber: | 3052433337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME0082367 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 174400000X | A65611 | CA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00A656110 | 05 | CA | MEDICAID | 278204900 | 05 | FL | MEDICAID |