Individual
JIM WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2210 E CALVADA BLVD, PAHRUMP, NV 89048-5804
(775) 727-6400
(775) 727-7543
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 877-5199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
907
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962614388
—
NV
01
—
P00928524
RR MEDICARE
NV
Enumeration date
05/06/2007
Last updated
11/19/2024
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