Provider Demographics
NPI:1275627820
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE MMC 292
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-6401
Mailing Address - Fax:
Practice Address - Street 1:THE CENTER FOR PROSTATE CANCER
Practice Address - Street 2:420 DELAWARE STREET SE, MAYO BUILDING, FOURTH FLOOR
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN397112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN557R9WAOtherBLUE CROSS BLUE SHIELD
MNB002OtherCHAMPUS
MN110486OtherFAIRVIEW
MN24-00143OtherMEDICA - CHOICE
MN977014300Medicaid
MNHP31003OtherHEALTHPARTNERS
MT0079033Medicaid
IA0581330Medicaid
MN1079981OtherARAZ
MN24-02006OtherMEDICA - PRIMARY
MN1025051OtherPREFERREDONE
MN128600OtherUCARE
MN24-00180OtherMEDICA
WI34230700Medicaid
MN977014300Medicaid