Provider Demographics
NPI:1144425786
Name:WANG, DIANA YUN-GUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:YUN-GUAN
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12200 RENFERT WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5654
Mailing Address - Country:US
Mailing Address - Phone:512-451-8211
Mailing Address - Fax:512-450-1146
Practice Address - Street 1:12200 RENFERT WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5654
Practice Address - Country:US
Practice Address - Phone:512-451-8211
Practice Address - Fax:512-450-1146
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN1214207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206850401Medicaid
TX8L18042Medicare PIN