Provider Demographics
NPI:1275767956
Name:WAN, ZHINIAN (MD)
Entity Type:Individual
Prefix:
First Name:ZHINIAN
Middle Name:
Last Name:WAN
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 1:702 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1199
Mailing Address - Country:US
Mailing Address - Phone:575-748-8301
Mailing Address - Fax:575-748-8304
Practice Address - Street 1:606 N 13TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1133
Practice Address - Country:US
Practice Address - Phone:575-748-8301
Practice Address - Fax:575-748-8304
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118139207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FZ658AMedicare PIN