Individual
CHIACHIEN JAKE WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 KINGS HWY, SHREVEPORT, LA 71103-3950
(318) 212-4639
(318) 212-8305
Mailing address
PO BOX 1684, SHREVEPORT, LA 71165-1684
(318) 424-4088
(855) 230-1466
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
304912
LA
390200000X
Student in an Organized Health Care Education/Training Program
BP10047559
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
CT
Other
Enumeration date
06/26/2012
Last updated
04/27/2018
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