Individual
JIN WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6339
(314) 251-4564
Mailing address
621 S NEW BALLAS RD, SUITE 3016B, SAINT LOUIS, MO 63141-8232
(314) 251-6339
(314) 251-4564
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2009017032
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477790459
—
MO
01
—
P00757987
RAILROAD MEDICARE
MO
01
—
P01142573
RAILROAD MEDICARE
MO
Enumeration date
01/13/2009
Last updated
12/01/2014
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