Individual provider Active NPI

Ken S Wang, MD

  • Child & Adolescent Psychiatry Physician
  • Tacoma, WA
National Provider Identifier
1851474308
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
MD60171772 Issued in WA
Practice address
1220 Division Ave
Tacoma, WA 98403-1321
Phone
(253) 403-1685
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD60171772 WA
Child & Adolescent Psychiatry Physician 2084P0804X MD60171772 WA Primary

Addresses

Primary practice location

1220 Division Ave
Tacoma, WA 98403-1321

Mailing address

1220 Division Ave
Tacoma, WA 98403-1321
Phone (253) 403-1685

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170501001930 WA Practitioner - Psychiatry 4385814458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

200 Lilly Rd NE
Suite C
Olympia, WA 98506-5080
Phone (360) 933-0368

315 Martin Luther King Jr Way
Tacoma, WA 98405-4234
Phone (253) 403-2130

317 Martin Luther King Jr Way
Tacoma, WA 98405-4234

317 MLK Jr Way
Multicare Social Work Serv
Tacoma, WA 98405-4234
Phone (253) 403-1126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60171772WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Mar 11, 2017 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Pediatrics CurrentSince Mar 11, 2017 Accepting new patients

Locations

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

1220 Division Ave
Tacoma, WA 98403
Phone (253) 403-1465

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1851474308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 DIVISION AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984031321",
            "telephone_number": "253-403-1685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 DIVISION AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984031321",
            "telephone_number": "253-403-1685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "KEN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60171772",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "WA",
            "license": "MD60171772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.