Provider Demographics
NPI:1063652147
Name:WANG, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 IMPALA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4871
Mailing Address - Country:US
Mailing Address - Phone:210-567-5176
Mailing Address - Fax:210-567-4793
Practice Address - Street 1:7703 FLOYD CURL DRIVE, MS 7736
Practice Address - Street 2:UTHSCSA, DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-567-5176
Practice Address - Fax:210-567-4793
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6092207PE0004X
CAA120264207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services