Basic Information
| Provider Information | |||||||||
| NPI: | 1447542600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YUANCONG WANG DO PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4373 UNION ST | ||||||||
| Address2: | SUITE C-B | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113553045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188863877 | ||||||||
| FaxNumber: | 7188863995 | ||||||||
| Practice Location | |||||||||
| Address1: | 4373 UNION ST | ||||||||
| Address2: | SUITE C-B | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113553045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188863877 | ||||||||
| FaxNumber: | 7188863995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2011 | ||||||||
| LastUpdateDate: | 05/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | WANG | ||||||||
| AuthorizedOfficialFirstName: | YUANCONG | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 7188863877 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 229200 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 02641041 | 05 | NY | MEDICAID |