Provider Demographics
NPI:1003250457
Name:WANG, CONNIE MENGYAN (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MENGYAN
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 FM 1463 RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6545
Mailing Address - Country:US
Mailing Address - Phone:281-612-0050
Mailing Address - Fax:
Practice Address - Street 1:4603 FM 1463 RD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6545
Practice Address - Country:US
Practice Address - Phone:281-612-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-28
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9076207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology