Individual
JONATHAN WAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(786) 624-2825
(305) 669-6531
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(786) 624-2825
(305) 669-6531
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS19875
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/20/2020
Last updated
07/10/2024
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