Provider Demographics
NPI:1114106887
Name:JIMIN WANG, MD, PA
Entity Type:Organization
Organization Name:JIMIN WANG, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-272-6442
Mailing Address - Street 1:9888 BELLAIRE BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3431
Mailing Address - Country:US
Mailing Address - Phone:713-272-6442
Mailing Address - Fax:713-995-7902
Practice Address - Street 1:9888 BELLAIRE BLVD STE 122
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3431
Practice Address - Country:US
Practice Address - Phone:713-272-6442
Practice Address - Fax:713-995-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8248Medicare PIN
TXI04972Medicare UPIN