Provider Demographics
NPI:1871813691
Name:WANG, EVEN FENGYUAN (MD)
Entity type:Individual
Prefix:DR
First Name:EVEN
Middle Name:FENGYUAN
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 1:120 MCMILLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2060
Mailing Address - Country:US
Mailing Address - Phone:220-564-7985
Mailing Address - Fax:220-564-7986
Practice Address - Street 1:120 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1809
Practice Address - Country:US
Practice Address - Phone:220-564-7985
Practice Address - Fax:220-564-7986
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1229692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123140Medicaid
OH0123140Medicaid