Provider Demographics
NPI:1962812727
Name:WANG, LIBO (MD)
Entity type:Individual
Prefix:DR
First Name:LIBO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9625 S GLASS SLIPPER RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6305
Mailing Address - Country:US
Mailing Address - Phone:801-913-3392
Mailing Address - Fax:
Practice Address - Street 1:50 N 1900 E ROOM 4A100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2200
Practice Address - Country:US
Practice Address - Phone:801-585-7676
Practice Address - Fax:801-581-7735
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137872207R00000X
UT5581753-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine