Provider Demographics
NPI:1144368614
Name:WANG, YUE (OMD)
Entity type:Individual
Prefix:DR
First Name:YUE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 GULFPORT BLVD S STE 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2127
Mailing Address - Country:US
Mailing Address - Phone:727-384-4826
Mailing Address - Fax:727-384-4826
Practice Address - Street 1:6801 GULFPORT BLVD S STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2127
Practice Address - Country:US
Practice Address - Phone:727-384-4826
Practice Address - Fax:727-384-4826
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist