Provider Demographics
NPI:1730165598
Name:WANG, JIANXUN (MD)
Entity type:Individual
Prefix:DR
First Name:JIANXUN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ANESTHESIA
Mailing Address - Street 2:144 GOULD ST.
Mailing Address - City:NEEDHAM HEIGHTS
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:339-204-9516
Mailing Address - Fax:617-754-8791
Practice Address - Street 1:MOUNT AUBURN HOSPITAL, DEPARTMENT OF ANESTHESIA
Practice Address - Street 2:330 MT. AUBURN ST
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-499-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212482207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0196801Medicaid
H64898Medicare UPIN
MAA3424401Medicare PIN
MA0196801Medicaid