Individual
JIM C. WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 STADIUM DR, MORGANTOWN, WV 26506-7900
(304) 598-4820
(304) 293-6963
Mailing address
393 E WALNUT ST, PHR GROUP PROVIDER ENROLLMENT 3RD FL, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A79074
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A790740
—
CA
05
—
3810009324
—
WV
01
—
P00416436
RAILROAD MEDICARE
WV
Enumeration date
11/30/2006
Last updated
12/01/2021
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