Provider Demographics
NPI:1144674045
Name:WANG, KAIHUA (DPM)
Entity type:Individual
Prefix:
First Name:KAIHUA
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5967
Mailing Address - Country:US
Mailing Address - Phone:901-309-7700
Mailing Address - Fax:901-507-3297
Practice Address - Street 1:8055 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5967
Practice Address - Country:US
Practice Address - Phone:901-309-7700
Practice Address - Fax:901-507-3297
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001303A213ES0103X, 213ES0103X
KY246910213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery