Provider Demographics
NPI:1174288120
Name:WANG, SHUAI JAY
Entity type:Individual
Prefix:MR
First Name:SHUAI
Middle Name:JAY
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GOLF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8609
Mailing Address - Country:US
Mailing Address - Phone:318-349-2809
Mailing Address - Fax:
Practice Address - Street 1:12 GOLF CLUB DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8609
Practice Address - Country:US
Practice Address - Phone:318-349-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008381712342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company