Provider Demographics
NPI:1124004783
Name:WANG, XIN (MD)
Entity Type:Individual
Prefix:
First Name:XIN
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 1:9750 BELLAIRE BLVD
Mailing Address - Street 2:STE 180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3445
Mailing Address - Country:US
Mailing Address - Phone:713-270-0909
Mailing Address - Fax:
Practice Address - Street 1:9999 BELLAIRE BLVD STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3579
Practice Address - Country:US
Practice Address - Phone:713-270-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7919208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165914602Medicaid