Provider Demographics
NPI:1699746081
Name:WANG, HERBERT L (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:L
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:4230 BRIDGEPORT WAY W STE B
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4335
Mailing Address - Country:US
Mailing Address - Phone:253-779-6325
Mailing Address - Fax:253-627-8792
Practice Address - Street 1:1802 YAKIMA AVE STE 103
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5303
Practice Address - Country:US
Practice Address - Phone:253-272-1077
Practice Address - Fax:253-627-8792
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000438222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8398801Medicaid
WA1699746081Medicare NSC