Provider Demographics
NPI:1063953354
Name:WANG, ALLISON LININ
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LININ
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S STATE ROAD 7 STE 122
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6136
Mailing Address - Country:US
Mailing Address - Phone:650-660-9708
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7 STE 122
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6136
Practice Address - Country:US
Practice Address - Phone:561-440-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036171040207N00000X
390200000X
FLME149395207N00000X
IN01086345A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program