Provider Demographics
NPI:1245406263
Name:JEFF J WANG DO PA
Entity Type:Organization
Organization Name:JEFF J WANG DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-920-3232
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2437
Mailing Address - Country:US
Mailing Address - Phone:281-920-3232
Mailing Address - Fax:281-920-3558
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2437
Practice Address - Country:US
Practice Address - Phone:281-920-3232
Practice Address - Fax:281-920-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178437301Medicaid
TXH63989Medicare UPIN
TX00752TMedicare PIN