Provider Demographics
NPI:1295826774
Name:WANG, YI-ZARN (MD)
Entity Type:Individual
Prefix:
First Name:YI-ZARN
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 1:701 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4206
Mailing Address - Country:US
Mailing Address - Phone:432-335-2222
Mailing Address - Fax:432-335-1693
Practice Address - Street 1:701 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4206
Practice Address - Country:US
Practice Address - Phone:432-335-2222
Practice Address - Fax:432-335-1693
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD10961R208600000X
TXR36172086X0206X, 208600000X
LA10961R2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1995606Medicaid
MS05334356Medicaid
LAF92906Medicare UPIN
LA1995606Medicaid
LA5U748Medicare PIN
LA020039516Medicare PIN