Provider Demographics
NPI:1154610137
Name:WANG, OLIVIA J (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:J
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 W TWAIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6721
Mailing Address - Country:US
Mailing Address - Phone:702-458-4263
Mailing Address - Fax:
Practice Address - Street 1:10135 W TWAIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6721
Practice Address - Country:US
Practice Address - Phone:702-458-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV17143207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS25988OtherNEVADA STATE BOARD OF PHARMACY
NV17143OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS