JACK KY WANG Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041763

License Status

EXPIRED

Business

First Name

JACK KY

Last Name

WANG

Business Name

JACK KY WANG

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2003

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006