Nkechi A Wan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12011225A Issued in IN

Practice address

2828 E State Blvd
Suite B
Fort Wayne, IN 46805-4761

Phone

(260) 482-6689

Fax

(260) 482-6948

NPI assigned

Sep 3, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220400000000",
    "number": "1306094354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 E STATE BLVD",
            "address_2": "SUITE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054761",
            "telephone_number": "260-482-6689",
            "fax_number": "260-482-6948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 E STATE BLVD",
            "address_2": "SUITE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054761",
            "telephone_number": "260-482-6689",
            "fax_number": "260-482-6948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAN",
        "first_name": "NKECHI",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2008-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011225A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arthur A Walus, CRNA
• Erica L Walworth, MS LMFT CEDS RDN LD
• Christina J Walz, M.D.
• Duane M Wampler, PA-C
• Meagan Wampler, DPT
• Xiaoying Wan, M.D.
• David R Wang, DO, MPH
• Jun Wang, M.D.
• Qi Wang, M.D.
• Steven Wang, MD

• Dentist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.