Individual
JIAQIONG WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-7237
(215) 707-9389
Mailing address
3500 N BROAD ST RM 1A, PHILADELPHIA, PA 19140-4106
(215) 926-9019
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
MD476775
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
03/24/2016
Last updated
04/26/2022
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