Basic Information
| Provider Information | |||||||||
| NPI: | 1851826788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | JUN CHIH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 22ND AVE S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337052933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273100925 | ||||||||
| FaxNumber: | 7274985470 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 22ND AVE S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337052933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273100925 | ||||||||
| FaxNumber: | 7274985470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2017 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME141976 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.